Mo1526 What Motivates Weight Loss Surgery Patients? Nayna A. Lodhia, Jaffer M. Kattan, Dylan Gwaltney, Kate E. Kiely, Shushmita Ahmed, Homero Rivas, John M. Morton Background By better understanding patient motivations, patient education can be individual- ized for the most effective healthcare possible. The purpose of this study was to evaluate patient motivations for bariatric surgery. Methods Preoperative, three, six and twelve month postoperative data were prospectively obtained for 169 consecutive laparoscopic Roux-en Y gastric bypass surgery patients at a single academic institution. All patients were given a standardized multiple choice questionnaire which asked them about their primary motiva- tions for bariatric surgery preoperatively, then 6 and 12 months postoperatively. Results Better health was the primary motivator preoperatively and at 12 months postoperatively (87, 89%, respectively). A better appearance was a primary motivation for only 15% of patients preoperatively and 20% of patients 12 months postoperative. Within health-related motivations for bariatric surgery, 29% of patients expressed a primary desire to live longer preoperative and, by 12 months postoperatively, this number increased to 38.7% of patients postoperatively. The primary motivation for bariatric surgery from a family perspective was to have more energy with children preoperatively and remained so at 12 months postoperat- ively (44 to 46%). The second most common familial motivation was to be a healthy role model which did not change from pre- to post-operatively (29.8 to 29.5%). Preoperatively, 65% of patients thought that diet and exercise would be the most important factor to maintain long-term weight loss; however, by 12 months postoperatively, only 56% of patients thought that diet and exercise would be the most important factor. Patients gave an increasingly greater role to surgery as an important factor for weight loss raising its importance from 45% preop to 58% at one year postoperatively. Observed to patient- expected (O:E) ratios of 12 month percent excess weight loss became more accurate as patients progressed from preop to 6 and 12 months postop (0.60, 0.70, 0.78). Pre-operative O:E Ratios of percent excess weight loss were strongly correlated with 12 postoperative excess weight loss (p<0.001). Conclusions Patients had increasingly, more realistic expectations for surgery's role and ideal weight. Preoperatively, accurate patient expectation of surgical weight loss resulted in better observed post-op weight loss. Patient motivation may be a prime factor for weight loss and should be harnessed for improved outcomes. Mo1874 Persistent Symptoms Following Cholecystectomy is Unacceptably High and in Need of Further Evaluation Rami Radwan, Chris Brown, Jonathan Lloyd-Evans, Chirag Patel, Omer Jalil, Ashraf M. Rasheed Introduction: Up to 20% of patients undergoing cholecystectomy continue to experience symptoms. We consider such results unacceptably high and in need of further evaluation. Objectives: To identify the biliary symptoms for which the cholecystectomy was carried S-1085 SSAT Abstracts out and then determine the prevalence and the nature of persistent symptoms following cholecystectomy in a cohort of 500 consecutive cases. Methods: A validated pre-operative symptoms survey was completed at the time of listing of 500 consecutive laparoscopic cholecystectomies (LC) followed by a follow up phone survey 12 weeks after the procedure to record the nature, severity and frequency of symptoms experienced pre- and post- operatively. A detailed clinical profiling was carried out on all patients with persistent biliary symptoms. Results: All patients had at least 2 symptoms pre-operatively and 337 (67.4%) had 3 or more. The most common symptoms pre-operatively were abdominal pain (93.8%), nausea (65.8%), pain related to food (54.4%) and bloating (48.6%). A total of 90 patients were symptomatic post-operatively. Eighty one patients (16.2%) complained of abdominal pain, while 63 (12.6%) patients also experienced associated dyspeptic symptoms. Seventy three patients (14.6%) developed 1 or more new symptoms post-operatively, the most common being heartburn found in 34 (6.8%) and abdominal bloating in 29 (5.8%). Sixty patients underwent further investigation following LC; 36 patients went on to have a second- ary diagnosis made, the most common (13/36) being hiatus hernia, seven patients were found to have a retained common bile duct stone. Overall, there was no significant difference in histology among patients post-operatively. Conclusion: A significant number of patients continue to experience symptoms following laparoscopic cholecystectomy. In patients were pain was the most troublesome symptom pre-operatively, significant symptomatic improve- ment was noted. Similarly, those patients that experienced symptoms more dyspeptic in nature pre-operatively were less likely to be symptom free following LC. A careful biliary history, a focused physical examination and a thorough pre-operative assessment must be carried out prior to LC to rule out conditions that masquerade as gallbladder disease. Mo1875 Human Growth Hormone (hGH) Abolishes the Negative Effects of Everolimus on Intestinal Anastomotic Healing Markus A. Küper, Jürgen Weinreich, Frank Traub, Alfred Königsrainer, Stefan Beckert Introduction: The mTOR-inhibitor everolimus inhibits healing of intestinal anastomoses by interfering with the inflammatory phase of healing and reducing collagen deposition. Aim of this study was to investigate whether the simultaneous administration of everolimus and hGH abolishes the negative effects of everolimus on anastomotic healing. Methods: 48 male Sprague-Dawley-rats were randomized to three groups of 16 animals each (I: vehicle; II: everolimus 3mg/kg p.o.; III: everolimus 3mg/kg p.o. + hGH 2,5mg/kg s.c.). Animals were pre-treated with hGH and/or everolimus daily for seven days. Then a standard anastomosis was created in the descending colon and treatment was continued for another seven days. The anastomosis was resected in toto and mechanical, biochemical and histological parameters of intestinal healing were assessed. Results: Anastomotic bursting pressure was significantly reduced by everolimus and a simultaneous treatment with hGH resulted in considerably higher values (I: 134±19, II: 85±25, III: 114±25 mmHg; p<0,05 I vs. II; p=0,09 I vs. III and II vs. III) Hydroxyproline concentration was significantly increased by hGH compared to everolimus alone (I: 14,9±2,5, II: 8,9±3,6, III: 11,9±2,8 μg/mg; p< 0,05 I vs. II/III and II vs. III). The number of MPO-positive cells was reduced significantly by hGH compared to everolimus alone (I: 10±1, II: 15±3, III: 9±2 n/sqmm; p<0,05 I vs II und II vs. III), while the number of PCNA-positive cells were increased by hGH (I: 28±3, II: 12±3, III: 26±12 / sqmm; p<0,05 I vs. II und II vs. III). Corresponding to these biochemical findings, HE- histology revealed significantly increased amount of granulation tissue in hGH-treated animals. Conclusion: The inhibitory effects of everolimus on intestinal wound healing can be partially neutralized by simultaneous treatment with human growth hormone. hGH- treatment addresses both the inflammatory phase as well as collagen deposition. Mo1876 Intestinal Permeability for Macromolecules Following Mechanical Ileus in Mice Xue Zhao, Till Macheroux, Michael S. Kasparek, Mario H. Mueller, Martin E. Kreis Introduction: Acute mechanical ileus is a frequent disorder seen in general surgery which - if untreated - terminates in peritonitis secondary bacterial translocation. We aimed to investigate the time course of changes in gut permeability during acute mechanical ileus for molecules of different molecular weight. Methods: C57Bl6 mice were anesthetized by isoflur- ane inhalation and gavaged with flourescein isothiocyanate conjugated dextrane (FITC- dextrane, 4.4 kDa) and horseradish peroxidase (HRP, 40 kDa). After a mini- laparotomy, the small intestine was ligated approximately 5 cm distal to the ligament of Treitz, while controls received a mini-laparotomy only. Intestinal permeability was assessed in ileus animals or controls 3 and 9 hours later in different subgroups (each n=4). For this purpose blood was taken by right ventricular puncture and serum concentrations of FITC-dextrane and HRP determined by spectrophotometry. Data are mean±SEM. Results: At 3 hours after the beginning of mechanical ileus, the FITC-dextrane concentration was 187±7.6 ng/ml in ileus animals and 147±8.1 ng/ml in sham controls (p<0.05), while it was 86±8.9 and 62±0.8 ng/ ml at the 9 hour time point (p<0.05). For the bigger molecule, HRP, concentrations at 3 hours were 5.6±3.6 ng/ml in ileus animals and 4.1±1.6 ng/ml in sham controls which was not different. At 9 hours the serum concentrations were 23.0±4.3 ng/ml in ileus animals which was higher compared to 9.0±3.1 ng/ml in sham controls (p<0.05). Conclusions: Intestinal permeability for macromolecules increases a few hours after acute mechanical ileus. It seems that soon after the beginning of mechanical ileus, intestinal permeability is increased for small-sized molecules, while it takes a few hours more until it is also increased for bigger sized molecules. SSAT Abstracts