Abstract: FR-PO643
Laparoscopic Gastric Sleeve Surgery in a Patient on Peritoneal Dialysis
Session Information
- Trainee Case Reports - IV
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 703 Dialysis: Peritoneal Dialysis
Authors
- Nguyen, Anthony, LSUHSC School of Medicine, New Orleans, Louisiana, United States
- Yazdi, Farshid, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana, United States
- Naljayan, Mihran V., LSUHSC School of Medicine, New Orleans, Louisiana, United States
Introduction
The high prevalence of obesity along with its potential resulting conditions make obesity a major public health concern. Morbid obesity is a limiting factor for a dialysis patient to obtain a kidney transplant. While an obese patient may elect to undergo bariatric surgery to induce weight loss, there is little data on this type of surgery involving a PD patient. We present a rare case of a patient with end-stage kidney disease (ESKD) on PD who underwent laparoscopic gastric sleeve surgery while maintained on PD.
Case Description
A 66-year-old morbidly obese female patient with ESKD on PD underwent laparoscopic gastric sleeve surgery. Prior to her surgery, she was 124 kg and was on continuous cyclic peritoneal dialysis (CCPD) for 9 hours with 4 cycles of 3000 mL 2.5% dextrose solution with 500 mL icodextrin last fill. Her adequacy prior to surgery was residual renal (RR) Kt/V 0.45 and PD Kt/V 1.56 for a total of 2.01. She cycled the night before her surgery and did not do a last fill. She received clindamycin 600 mg IV perioperatively (allergy to cefazolin) and post operatively, she held PD the first night, then initiated 1000 mL 2.5% dextrose for 6 cycles over 12 hours. At day 5 post operatively, it was increased to 1500 mL for 6 cycles over 12 hours due to low drain alarms. After 3 weeks, it was increased to 2500 mL alternating 1.5% and 2.5% dextrose for 4 cycles over 9 hours. Her adequacy 4 weeks postoperatively was RR Kt/V 1.03, PD Kt/V 1.11, and total 2.15. Two months postoperatively she was 113 kg.
Discussion
One particularly interesting observation regarding this case is the fact that the patient’s RR Kt/V improved after her surgery also leading to an increase in her total adequacy. This case illustrates how PD patients undergoing bariatric surgery can successfully be maintained on PD post-operatively without having to transition temporarily to hemodialysis and without sacrificing renal adequacy. Being allowed to continue PD as opposed to hemodialysis allows for the patient to avoid potential complications involved with a catheter and leads to a goal weight suitable for transplantation.