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bariatric surgery and diverticulitis

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bariatric surgery and diverticulitis

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    1. Bariatric Surgery and Diverticulitis Matthew Fabian DO PGYV University of North Dakota Department of Surgery

    3. Introduction-Obesity In the United States: 3.8 million people are over 300 pounds, over 400,000 people (mostly males) carry over 400 pounds and the average adult female weighs 163 pounds 171,000 Bariatric surgeries in US in 2005 ½-1% of all eligible patients are being offered bariatric surgery

    8. Introduction-Diverticulosis Diverticular disease is common. Rare below the age of 40 years Increases with age 1/3 with disease by age 60 years 2/3 by age 85 years only 10–25% of patients will develop symptoms Of symptomatic, only 15% will develop a serious complication as a result of a diverticular perforation Peritonitis Abscess Multiple episodes of Mortality of those requiring surgery for perforated diverticular disease is between 12 and 36% “Anecdotally, surgeons often comment that patients presenting with perforations are overweight.”

    9. Diverticulitis and Obesity Obesity is a risk factor for perforated diverticulitis Reason for association is unclear Diet, Exercise, Other?

    10. Diverticulitis and Obesity 1983-1990 Admissions with Diverticulitis=248 Under 40 Years of age=29(11.7%) 96.5% Overweight 17% Morbidly Obese

    12. A comparison of the meandifferences in BMI for each clinicalgroup and controls.

    13. Diverticulitis and Obesity HPFS 362/43,881 New Cases in 4 years Dietary fiber intake (insoluble) Physical activity (vigorous)

    15. Bariatric Surgery and Diverticulitis No published series on this specific topic “Unanticipated findings at bariatric surgery” by Greenbaum 2005

    16. Hypothesis Bariatric surgery is effective in lowering risk of diverticulitis

    17. Methods Reviewed Patients at Altru Hospital with Diagnosis codes: 562.11 Diverticulitis of the colon without hemorrhage 278.01 Morbid Obesity, 278 Obesity V45.86-Bariatric surgery status

    18. Results There were 56 Diverticulitis patients identified over the time period 10/2006-8/2007 2 with Diverticulitis and Morbid Obesity= 4% (95%CI +/-5) 0 Diverticulitis patients had history of Bariatric Surgery 95%CI +/-0.009 P=0.16

    19. Conclusions Historically obesity is associated with diverticulitis Bariatric surgery, the only proven reliable means of weight loss, should reduce risk of diverticulitis This series, while showing a trend towards prevention, does not support the hypothesis Confounding factors may be fiber in the diet and lack of exercise This series may have reached statistical significance if the sensitivity in coding for morbid obesity was greater. If 2 more pt with diverticulitis were diagnosed with morbid obesity, P would have been 0.04

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