Addressing the challenges of sleeve gastrectomy in end-stage renal disease: Analysis of 100 consecutive renal failure patients

Young Kim, Junzi Shi, Christopher M. Freeman, Andrew D. Jung, Vikrom K. Dhar, Shimul A. Shah, E. Steve Woodle, Tayyab S. Diwan

Research output: Contribution to journalArticlepeer-review


Background While previous studies have demonstrated short-term efficacy of laparoscopic sleeve gastrectomy in candidates awaiting renal transplantation, the combination of morbid obesity and end-stage renal disease presents unique challenges to perioperative care. We demonstrate how increasing experience and the development of postoperative care guidelines can improve outcomes in this high-risk population. Methods Single-center medical records were reviewed for renal transplantation candidates undergoing laparoscopic sleeve gastrectomy between 2011 and 2015 by a single surgeon. Postoperative care protocols were established and continually refined throughout the study period, including a multidisciplinary approach to inpatient management and hospital discharge planning. The first 100 laparoscopic sleeve gastrectomy patients were included and divided into 4 equal cohorts based on case sequence. Results Compared with the first 25 patients undergoing laparoscopic sleeve gastrectomy, the last 25 patients had shorter operative times (97.8 ± 27.9 min vs 124.2 ± 33.6 min), lower estimated blood loss (6.6 ± 20.8 mL vs 34.0 ± 38.1 mL), and shorter hospital duration of stay (1.7 ± 2.1 days vs 2.9 ± 0.7 days) (P <.01 each). Readmission rates, complications, and 1-year mortality did not differ significantly. Conclusion Increasing experience and the development of clinical care guidelines in this high-risk population is associated with reduced health care resource utilization and improved perioperative outcomes.

Original languageEnglish (US)
Pages (from-to)358-365
Number of pages8
JournalSurgery (United States)
Issue number2
StatePublished - Aug 2017
Externally publishedYes

ASJC Scopus subject areas

  • Surgery


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