0472 Enhanced Recovery Is Feasible in Bariatic Patients: Early Outcomes of Enhanced Recovery following Laparoscopic Roux-en-y Gastric Bypass

s / International Journal of Surgery 9 (2011) 495–546 538 ABSTRACTS Results: The procedure enabled restoration of oral diet and allowed restoration of run off for saliva. Conclusions: This is the first reported transcervical, radiologically guided technique to treat neopharyngeal stenosis following surgical treatment for head and neck cancer. It demonstrates a novel and efficacious approach to managing total neopharyngeal stenosis refractory to endoscopic dilatation. This safe and simple procedure may be considered in the management of this rare but significant complication. 0470 TOTAL LAPAROSCOPIC MANAGEMENT OF COLONIC PERFORATION WITH SIGMOID ‘PERFOROSTOMY’ Komal Patel, Ashish Sinha, Paolo Sorelli, Amir Razvi, Phillip Ng. University Hospital Lewisham, London, UK Aims:Minimal access surgery is under utilised in themanagement of colonic emergency. This study reports on the use of laparoscopy to manage colonic perforations. We describe an alternative approach to the conventional management of colonic perforations, solely using laparoscopic techniques. Methods: Sequential patients with non-neoplastic colonic perforation and evidence of minimal faecal contamination at laparoscopy were analysed. Following diagnostic laparoscopy, peritoneal toilet was achieved by copious lavage. The sigmoid colon was mobilised and the perforation site was exteriorised to form a stoma – ‘perforostomy’. Results: Two patients, 43 year old male and 66 year old female, presenting with idiopathic sigmoid perforation and delayed iatrogenic recto-sigmoid perforation post-polypectomy respectively, were managed utilising this approach. In both cases, the perforostomy was completed without conversion to open surgery. Successful reversal of their perforostomies was performed in the fourth post-operative month. Discussion: The modern management of colonic perforation is evolving. The above procedure can facilitate this process by providing an intermediate strategy between the traditional Hartmann's procedure or the more recent laparoscopic drain insertion for pelvic sepsis. The laparoscopic exteriorisation of the perforated site reported here represents a novel approach. It achieves faecal diversion without requiring the construction of a conventional stoma. 0472 ENHANCED RECOVERY IS FEASIBLE IN BARIATIC PATIENTS: EARLY OUTCOMES OF ENHANCED RECOVERY FOLLOWING LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS Michael Wilson, Ali Alhamdani, Kamal Mahawar, Maureen Boyle, Peter Small. Sunderland Royal Hospital, Sunderland, UK Aim:We introduced an enhanced recovery protocol (ERP) for our bariatric patients in May 2009. We have evaluated our early outcomes following laparoscopic roux-en-y gastric bypass (LRYGB). Methods: Our ERP includes: Ten day liver reducing diet; Catheters, nasogastric and postoperative surgical drains are not routinely used. Day 0 early ambulation and sips, day 1 free fluids, day 2 soft diet. Home on the 2nd/3rd postoperative day. We compared early outcomes in historical (group A, n1⁄4121) versus enhanced recovery patients (group B, n1⁄4188). Results: 309 patients underwent LRYGB between January 2005 and August 2010 with no mortality. Following the implementation of ERP we have reduced our operating time (3h21mv2h46m, p<0.0001) andpostoperative hospital stay (5.1 days v 2.7 days, p<0.0001) with no difference in early (<30d) readmission rates (9.1% v 4.8%, p1⁄40.1576). In both cohorts, 3 patients have required surgery in the early (<30d) postoperative period. This data includes the learning curve of all three of our surgeons. Conclusions:Wereport thesafeadoptionof anERP forLRYGB.Operating time and hospital stay have significantly reduced without evidence of adverse outcomes, some of which may be attributed to learning curve experience. 0474 VASCULAR SURGERY CASE REPORT: TRELLIS-8 PHARMACOMECHANICAL THROMBECTOMY SYSTEM FOR THE TREATMENT OF ILIOFEMORAL DEEP VENOUS THROMBOSIS JamesRigby , EllisHughes , Paul Ellis ,MarkCowling , SriramNarayanan . University Hospital of North Staffordshire, Stoke-on-Trent, UK; Keele University School of Medicine, Stoke-on-Trent, UK Aims: To present and discuss the first patient in our hospital to undergo treatment with Trellis-8 Pharmaco-Mechanical Thrombectomy (PMT) system for Iliofemoral deep venous thrombosis (DVT). Methods/Case: A 46 year old male presented with an acute painful swelling of the left thigh. Ultrasound (US) Doppler identified left common femoral/external iliac DVT. US guided percutaneous puncture of the left popliteal veinwas performed. The Trellis-8 catheter was advanced through the clot. Tissue Plasminogen Activator was delivered between two occlusion balloons positioned at opposite ends of the clot, while a powered oscillating wire caused clot breakdown and facilitated with clot aspiration via the catheter. Postprocedure venography demonstrated a patent venous system and clinically there was reduced leg swelling. The procedure was well tolerated with no complications and the patient had an overnight stay in surgical special care. Results/Discussion: Isolated Thrombolysis with Trellis-8 is characterised by reduced lytic dosage, shorter treatment times, reduced systemic effects of thrombolytics, maintenance of valvular function, lower costs and fewer long-term complications compared to conventional forms of DVT treatment. Conclusion: Trellis-8 enabled thrombus removal in a single visit to the interventional angiography suite. Continued surveillance and audit of a cohort of patients will determine long-term success rates. 0475 EVALUATION OF SURGICAL TEAM PERFORMANCE IN ELECTIVE OPERATIVE THEATRES Mohammed Hadi , Robertson Eleanor , Lauren Morgan , Sharon Pickering , Ken Catchpole , Damian Griffin , Peter McCulloch . University Hospital Coventery and Warwickshire, Coventry, West Midlands, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK; Warwick Medical School, Warwick,