Abstracts
2000 Digestive Disease Week

# 2335 Risks/Benefits of Gastric Bypass in Morbidly Obese Patients with Severe Venous Stasis Disease.
Harvey J. Sugerman, Elizabeth L. Sugerman, Luke Wolfe, John M. Kellum, Michael A. Schweitzer, Eric J. Demaria, Richmond, VA

Background: Central obesity is associated with increased intra-abdominal pressure causing increased inferior vena caval and femoral venous pressures with a risk of lower extremity venous stasis disease, pretibial ulceration and bronze edema. Objective: Determine risks and benefits of gastric bypass (GBP) induced weight loss on severe venous stasis disease in morbid obesity. Methods: The GBP data base was queried for venous stasis disease including pretibial venous stasis ulcers, bronze edema, cellulitis. Results: Of 1976 GBP patients, 64 patients (45% female) met criteria. Pretibial venous stasis ulcers:37, bronze edema:4, both:23, recurrent cellulitis: 17. All had 2-4+ pitting pretibial edema. Mean preop body mass index (BMI) was 61±12 kg/m2, weight 179±39 kg, 270±51 %ideal body weight (IBW). These were all greater (p<0.0001) than GBP without venous stasis disease (weight 142±30 kg, BMI 51±10 kg/m2, 226 ±41 %IBW, women 79%). 2 patients had a pulmonary embolus (PE) and 4 had Greenfield filters in the remote past. Additional co-morbidity: 19 obesity hypoventilation (OHS), 40 sleep apnea (SA), 46 hypertension (HTN), 22 gastroesophageal reflux (GER), 44 degenerative joint disease (DJD) symptoms, 17 Type II diabetes mellitus (DM), 2 pseudotumor cerebri (PC), 15 urinary incontinence (UI). Co-morbidities also more frequent (p<0.001) than GBP for non-venous disease. Greenfield filters placed in 12 OHS at GBP. At 3.9±4 y after surgery patients lost 55±21% of excess weight, 62±33 kg, reaching 40±9 kg/m2 BMI or 176±41% IBW. Venous stasis ulcers resolved in all but 1 within 1 year but recurred in 2 with weight regain. Bronze discoloration persisted in all but the edema resolved in all but 4 patients. Post weight loss comorbidity: 22/46 HTN, 22/44 DJD, 4/17 DM, 2/15 UI, and no OHS, SA, GER,or UI. Complications: 2 anastomotic leaks with peritonitis and death, 1 fatal PE, 1 fatal respiratory arrest, 5 major, 6 minor wound infections or seromas, 2 staple line disruptions, 8 marginal ulcers rx with acid suppresion, 7 stomal stenoses rx with endoscopic dilation, 3 late small bowel obstructions necessitating surgery in 1, and 23 incisional hernias. There were 4 late deaths: 1 PE, 1 MVA and 2 cardiac. Conclusions: Severe venous stasis disease was associated with a greater weight, BMI, male sex, comorbidity and risk (leak, death, incisional hernia) than other patients who underwent GBP. Surgically induced weight loss corrected the venous stasis disease in almost all patients as well as their other obesity co-morbidity problems.