Safety and effectiveness of bariatric surgery in dialysis patients

Mohammad Jamal, MD, MEd, FRCSC, Christopher R Daigle, MD, Stacy Brethauer, MD, FACS, Mathew Kroh, MD, FACS, Philip Schauer, MD, FACS. Cleveland Clinic.

Introduction
Chronic renal disease is known to affect adversely the results of bariatric surgery. There is paucity of literature on the safety and effectiveness of bariatric surgery on dialysis patients who are at a very advanced stage in their renal disease.

Methods
A retrospective review of a prospectively collected database was conducted for dialysis patients who underwent bariatric surgery between 01/06 and 01/13.Age, gender, BMI, cause of renal failure, associated comorbidities, type of surgery, early and late complications and mortality were collected.

Results
A total of 21 dialysis patients (0.7%) were identified out of 3048 patients undergoing bariatric surgery during the study period . Eighteen underwent laparoscopic Roux-en-Y gastric bypass (LRYGB), two patients underwent laparoscopic sleeve gastrectomy and one patient underwent laparoscopic adjustable gastric banding. Mean preoperative BMI was 48.84 ±5.53 and BMI decreased to 35.38 ±8.48. after a mean follow-up period of 2.3 years (Range = .12-6.5). Early complications (<30 days of surgery) occurred in 5 patients (23.8%). Three patients had a minor complication and two patients had a major complication. Four patients (19%) had a late complication including one marginal ulcer with bleeding managed endosopically, one patient small bowel obstruction requiring laparoscopic lysis of adhesions, one cholecystitis requiring cholecystectomy and one anastomotic stricture requiring dilatation. There was one death in this cohort at 45 days after LRYGB that was unrelated to a surgery..

Conclusion
Chronic renal failure requiring dialysis should not be considered a contraindication to bariatric surgery. Our experience with this patient population demonstrates excellent medium-term weight loss and acceptable early and late complication rates.
 

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