Mo2040

BARIATRIC SURGERY OUTCOMES IN PATIENTS WITH PREVIOUS ORGAN

TRANPLANTS: AN ANALYSIS OF THE MBSAQIP
Aryan Modasi, Jerry Dang, Noah Switzer, Daniel W. Birch, Shahzeer Karmali
Background As of 2017, the Metabolic and Bariatric Surgery Accreditation and Quality
Improvement Program (MBSAQIP) has started tracking the outcomes for bariatric surgery
patients having undergone a previous transplant procedure. Traditionally considered a high-
risk group, these patients often present unique challenges secondary to their inherent
comorbidities, immunosuppressant history, and technical/anatomic factors related to their
previous surgical history. Our study aims to look at the safety of bariatric surgery in this
patient population, and to compare outcomes based on procedure performed (laparoscopic
sleeve gastrectomy (LSG) vs laparoscopic Roux-en-Y gastric bypass (LRYGB)). Methods Data
was collected from the 2017 MBSAQIP database, which collects preoperative, intraoperative
and postoperative data from 832 centres in the United States and Canada based on standard-
ized definitions for variables specific to metabolic and bariatric surgery. Patients having
undergone an LSG or LRYGB were included for analysis. Patients with a history of a previous
bariatric surgery were excluded. A multi-variable logistic regression was performed to deter-
mine if a transplant history was independently associated with worse outcomes compared
to non-transplant patients. Outcomes were also compared amongst transplant patients
undergoing LSG versus LRYGB. Results A total of 156,310 patients were included for
analysis. Patients having undergone a previous transplant were found to be older (49.2 (SD
11.5) vs 44.4 (SD 12.0) years, p < 0.001), more likely to be male (37.0% vs 20.2%, p <
0.001), with a lower mean body mass index (42.8 vs 45.2 kg/m2,p < 0.001). Patients
with previous transplants had a significantly higher rate of associated comorbidities (renal
insufficiency, diabetes, steroid use, anticoagulation use). The major 30-day complication
rate after surgery was found to be three-fold higher in patients with a transplant history
(OR 9.24 vs 3.09, p < 0.001). Mortality was higher (0.42% vs 0.08%) but did not reach
statistical significance (p = 0.056). On multivariable analysis, previous transplant was as
independent predictor of major complications (OR 1.88 [1.17 to 3.02], p = 0.009). In
previously transplanted patients, LRYGB was associated with a higher complication rate
compared to LSG (13.3% vs 8.7%), but this did not reach significance (p = 0.408). Conclu-
sion The 30-day complication rate is three times higher amongst patients with a transplant
history undergoing bariatric surgery. As a group, transplant patients have a significantly higher
rate of associated comorbidities, however when assessed independently using multivariable
analysis previous transplant remains an independent predictor of worse outcomes. Both
patients and surgeons must be aware of this risk when determining candidacy for bariatric
surgery in this patient population.
Mo2059

EFFECT OF ADDITION OF PREOPERATIVE ORAL PREGABALIN TO

Mo2058
DOES CONCOMITANT MECKEL’S DIVERTICULECTOMY ALONG WITH AN
APPENDECTOMY INCREASE POSTOPERATIVE MORBIDITY?
Victor Vakayil, Zachary D. Miller, Cassaundra K. Burt, James V. Harmon
Background Meckel’s diverticulitis can mimic acute appendicitis. There exists a considerable
debate on the concomitant excision of a Meckel’s diverticulum during an appendectomy.
The risks of excision need to be weighed against the risk of developing postoperative
complications and future diverticulitis. We evaluate the postoperative morbidity following
PERIOPERATIVE INTRAVENOUS LIDOCAINE INFUSION ON
POSTOPERATIVE PAIN AND PERIOPERATIVE STRESS RESPONSE IN
PATIENTS UNDERGOING ELECTIVE LAPAROTOMY: A DOUBLE BLIND
RANDOMISED CONTROLLED TRIAL
Jigish Ruparelia, Sarath C. Sistla, Gomathi Shankar, Pankaj Kundra, Senthil Kumar
Introduction Postoperative pain remains a significant problem in patients undergoing
abdominal surgeries, and has a profound effect on patient recovery. High dose opioids
hamper bowel motility and increase nausea and vomiting. Intravenous lidocaine has been
used as part of a multimodal analgesia protocol for providing effective pain relief and

the concomitant excision of a Meckel’s diverticulum during an appendectomy. Methods We
performed a 12-year retrospective review of the ACS-NSQIP database from 2005-2016 and
identified patients undergoing Meckel’s diverticulectomy and/or appendectomy using ICD-
9/10 and CPT codes. Patients were then stratified into two cohorts; those undergoing an
appendectomy with concomitant diverticulectomy (AM) and those undergoing an appendec-
tomy alone (AA). To mitigate selection bias and adjust for baseline heterogeneity between
groups, we used propensity-score matching with a case (AM): control (AA) ratio of 1:2.
Both populations were matched on age, gender, demographics, severity of presentation
including ASA scores, wound classification scores and various preoperative laboratory
variables. We then compared intraoperative outcomes including operative time, 30-day
postoperative outcomes including infectious and non-infectious morbidity, and 30-day post-
operative mortality between groups. Results We identified 460 patients who underwent a
concomitant Meckel's diverticulectomy during an appendectomy (AM). As compared to the
AA group, on baseline, these patients had an increased proportion of baseline comorbidities
with poorer preoperative labs. Propensity-score matching helped identify 460 matched
controls from the AA group. Balance assessment demonstrated successful matching on all
baseline characteristics. Postoperative outcome evaluation (Table 1) demonstrated the AM
group to have increased operative time, with an increased duration of hospital stay (all P's
<0.05). The rate of postoperative infectious morbidity including superficial, deep and organ
space infections, urinary tract infections and rates of sepsis were similar between both
groups (all P>0.05). Rates of non-infectious morbidity, reoperation, and mortality were also
comparable between both groups (all P's >0.05). Conclusions In our review, concomitant
Meckel’s diverticulectomy with an appendectomy did not increase postoperative morbidity
or mortality compared to appendectomy alone. However, clinical decision to excise a Meckel’s
diverticulum concomitantly during an appendectomy should be made on an individual basis
based on the severity of presentation and comorbidity status.
SSAT Abstracts
attenuating surgery-associated inflammatory response. Preoperative pregabalin also has a
beneficial effect in reducing pain. This study was carried out to assess the efficacy of
combining these drugs in reducing pain, paralytic ileus and stress response. Methodology
All patients undergoing elective laparotomy and satisfying the study criteria were randomised
into two groups. Group A patients received preoperative placebo and intraoperative lidocaine
infusion. Group B patients received preoperative pregabalin and lidocaine. Pain was assessed
using visual analogue scale at 2, 6, 18 and 24 hours postoperatively. Morphine consumption
on a patient controlled analgesia pump was noted. Time to first passage of stools and flatus,
and incidence of nausea and vomiting were noted. Surgical stress response was assessed by
measuring perioperative total leucocyte count, interleukin-6 and C-reactive protein. Results
Postoperative pain scores at 6, 18 and 24 hours were significantly lower in Group B patients
who had received pregabalin. These patients also had lower morphine consumption and
earlier bowel recovery as measured by first passage of stools. Perioperative inflammatory
markers were similar in both groups. Discussion Preoperative pregabalin when used with
intravenous lidocaine has a synergistic effect on reducing postoperative pain and opioid
consumption. This also has beneficial effect on return of bowel function. However, it did
not have a significant additional effect on attenuation of the inflammatory component of
surgical stress response.
Mo2060
PREVENTING PORT-SITE (LATERAL) HERNIAS AFTER LAPAROSCOPIC
VENTRAL HERNIA REPAIR
Karla Bernardi, Oscar A. Olavarria, Nicole B. Lyons, Puja Shah, Alexis N. Milton, Lillian
S. Kao, Tien C. Ko, Mike K. Liang
Introduction: Lateral hernias due to port placement occur at a rate of 5% (0 – 30%) and
are an under-reported complication following laparoscopic ventral hernia repair (LVHR).
The majority of lateral hernias occur at previous 10-12 mm port incisions, which are often
needed to safely introduce large pieces of mesh. One way to avoid using such a complication
is to place the 10-12 mm port through the ventral hernia defect. However, there is theoretical
concern for increased risk of surgical site infection (SSI) with this technique. We hypothesized
that introducing mesh through a 10-12 mm port placed through the defect will decrease
the rate of lateral hernias with no increased risk of SSI. Methods: This is a prospective
cohort study of patients who underwent LVHR at a single academic institution from 2014-
2017. All patients had mesh introduced through a 10-12 mm port placed through the
ventral hernia defect. Observed outcomes were compared to expected outcomes based upon

S-1479 SSAT Abstracts