title: Bariatric Surgery in Patients with Dialysis-Dependent Renal Failure.
abstract: BACKGROUND
  Laparoscopic procedures for the treatment of morbid obesity are commonly offered to patients with comorbidities previously thought to carry prohibitive operative risk. In this study, we reviewed characteristics and perioperative outcomes of patients with dialysis-dependent renal failure (DDRF) who underwent laparoscopic bariatric procedures.
  
  
  METHODS
  The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2006 to 2011 was reviewed. Preoperative characteristics and 30-day outcome data of patients who underwent three common laparoscopic procedures were analyzed using ANOVA and Pearson chi-squared tests.
  
  
  RESULTS
  One hundred thirty-eight patients (52.5 % female) with DDRF and a median body mass index (BMI) of 45.5 kg/m(2) were identified; 33.8 % (n = 47) underwent laparoscopic banding (LAGB), 48.9 % (n = 68) laparoscopic Roux-en-Y gastric bypass (RYGB), and 16.5 % (n = 23) laparoscopic sleeve gastrectomy (LSG). No differences were found among groups in age, prevalence of American Society of Anesthesiology IV classification, BMI, weight, gender, prevalence of diabetes, and vascular or neurologic comorbidities. Total operation time and length of hospital stay were significantly different between groups. Mortality was 0.7 %, and overall morbidity was 5.8 %. The case mix reflected a decrease in LAGB procedures from 45.5 to 23.3 % from 2006-2009 to 2010-2011 and an increase in LSG procedures from 9.1 to 24.7 % (p < 0.006).
  
  
  CONCLUSIONS
  When performed in selected DDRF patients, bariatric surgery is safe. An increase in LSG with a concurrent decline in LAGB procedures was demonstrated over the period of the study.
authors.affiliation: Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, NC, USA. mozera@ecu.edu.
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Mozer
authors.affiliation: Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, NC, USA. penderjo@ecu.edu.|Division of Advanced Laparoscopic, Gastrointestinal and Endocrine Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA. penderjo@ecu.edu.
authors.forename: John R
authors.initials: JR
authors.lastname: Pender
authors.affiliation: Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, NC, USA. chapmanw@ecu.edu.|Division of Advanced Laparoscopic, Gastrointestinal and Endocrine Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA. chapmanw@ecu.edu.
authors.forename: William H H
authors.initials: WH
authors.lastname: Chapman
authors.affiliation: Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, NC, USA. sippeym@ecu.edu.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Sippey
authors.affiliation: Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, NC, USA. poriesw@ecu.edu.|Division of Advanced Laparoscopic, Gastrointestinal and Endocrine Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA. poriesw@ecu.edu.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Pories
authors.affiliation: Department of Surgery, The Brody School of Medicine at East Carolina University, Greenville, NC, USA. spaniolask@ecu.edu.|Division of Advanced Laparoscopic, Gastrointestinal and Endocrine Surgery, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA. spaniolask@ecu.edu.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spaniolas
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods* / Q000706:statistics & numerical data; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D061646:Operative Time; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology
keywords: Adjustable band; Bariatric surgery; Dialysis; End-stage renal failure; Gastric bypass; Sleeve gastrectomy
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