Surgeons at the University of Illinois Hospital & Health Sciences System are developing new treatment options for obese kidney patients.
Many U.S. transplant centers currently refuse to transplant these patients due to poorer outcomes.
By simultaneously undergoing two procedures — robotic-assisted kidney transplantation and robotic-assisted sleeve gastrectomy — patients have only one visit to the operating room and one general anesthesia. Surgeons can utilize the same minimally invasive incisions.
Aidee Diaz, a 35-year-old Chicago woman, is the first patient in the world to have the combined procedure, according to UI surgeons. When Diaz was diagnosed with kidney disease and high blood pressure five years ago, doctors began intensive treatment, including chemotherapy and steroids, to treat abnormal protein production that was causing her kidney disease.
In Diaz’s case, her weight jumped from 180 pounds to 300 pounds, and she needed dialysis three times a week.
“Many obese patients come to us because they have been excluded from transplant waiting lists or been told that they must lose weight prior to transplantation,” said Dr. Enrico Benedetti, professor and head of surgery at UIC. “Unfortunately, successful weight loss in patients with chronic illness is uncommon and often unrealistic.”
On July 9, Dr. Subhashini Ayloo, assistant professor of surgery at UIC, performed the robot-assisted sleeve gastrectomy by removing 70 percent of Diaz’s stomach. The procedure created a smaller stomach through which ingested food can enter the digestive tract without diverting or bypassing the intestines.
Immediately following the sleeve gastrectomy procedure, Benedetti performed a living-related kidney transplant. Diaz said she appreciates the gift of both procedures — having kidney function with weight loss.
Surgeons at the UI Hospital routinely perform robotic-assisted kidney transplantation (more than 65 cases since 2009) and sleeve gastrectomies for weight loss (more than 150 since 2007). The team has data, in press, demonstrating the safety of robotic kidney transplantation in obese patients with a body mass index above 40 and up to 60.
“The combination of gastric sleeve surgery and kidney transplantation could provide patients with the greatest benefit post-transplantation, when there is the greatest risk related to the combined complications of obesity and renal failure,” said Ayloo, who is principal investigator of an ongoing clinical trial to evaluate the safety and effectiveness of the combined procedure.
The trial will determine whether simultaneous robotic-assisted kidney transplant and sleeve gastrectomy has fewer surgical complications and better medical outcomes for obese patients with end-stage renal disease compared to kidney transplant alone. The institutional review board (IRB) has approved the protocol but the trial is ongoing and results are not yet available.
Co-investigators include Benedetti, Dr. Pier Giulianotti, Dr. Jose Oberholzer and Dr. Ivo Tzvetanov of UIC.
Previous studies have reported outcomes of other laparoscopic bariatric procedures (gastric bypass and gastric banding) before and after kidney transplantation, but there is no data on sleeve gastrectomy combined with kidney transplantation, Ayloo said.
Source: Science Daily
Bariatric surgery consists of a variety of life altering surgical interventions that can help you reach a healthy weight. These interventions can improve your quality of life if you fit within the guidelines. These guidelines help your physician and potential bariatric surgeon decide if surgical treatment is right for you.
Basic Eligibility for Weight Loss Surgery: Whether you’re thinking about having a vertical sleeve gastrectomy or a more involved gastric bypass, basic eligibility requirements are the same. These requirements enable a candidate along with their physician to discern if this type of intervention is worth considering.
Age: Most candidates are between 18 and 65 years old. If you’re older than 65, surgery poses a higher risk. If you’re younger than 18, exceptions may be made if you are morbidly obese and have serious, life-threatening health problems.
Body Mass Index (BMI): Your body mass index determines your degree of obesity. If you have a BMI of 40 or more and have been obese for longer than five years, you qualify. For men, that is more than 100 pounds overweight, and for women, that is more than 80. If your BMI is 35 to 39, you must have high blood pressure, diabetes, heart disease or sleep apnea. A BMI of 30 doesn’t normally qualify, but exceptions would be serious life-threatening health issues.
Previous dieting attempts: Surgery isn’t performed just because you gain weight. To qualify for medical intervention, you should have a solid history of participating in dieting and exercise programs that haven’t improved your condition. This includes not being able to maintain your losses beneath a qualifying BMI.
Bariatric Weight Loss Team Evaluation: Once your physician recommends surgery, candidates receive additional evaluations from a team of experts. The long-term effects of this procedure require total compliance to dietary recommendations. You must demonstrate an ability to make the required lifestyle changes, which for some individuals include giving up smoking, excessive drinking and overcoming any addiction to drugs.
These meetings further determine if gastric sleeve surgery or a more invasive bariatric procedure is right for you. They examine your past dieting experiences, current eating and exercise habits, motivation for weight loss, ability to handle stress, medical condition, current medications and other important details. Problems in these areas do not automatically disqualify you from weight loss surgery. In some cases, your surgeon might decide you need to learn how to correct or manage a particular problem such as smoking before they perform the surgery. In some cases, you are also required to lose a certain amount of weight prior to treatment.
Article Source: EzineArticles
[Interviewer]: Hi everyone, this is Stephanie. She had a surgery yesterday? No, day before yesterday; today’s the home stretch. So she’s gonna kind of tell you about her experience and we’ll go from there.
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My name is Jennifer, I had lap band surgery in Tijuana, Mexico in March 2011. At the start of my pre-op diet, I was 264.8 lbs. and I am 5’4 tall. In less than 23 weeks, I have lost 80 lbs. at 184 lbs. I have struggled with my weight my whole life. In 2008, I lost my mother at 51 years old and then in 2010, I lost my father at 53 years old. At that point I started to question how much of life I had left to live. I felt like I was on a ticking time clock and I am only 34 years old!
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Jenn’s 6 Month Surgiversary Lap Band (Gastric Band) Montage
Jenn-1 Year After Lap Band Surgery – 128.6 Total Weight Loss
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BeliteWeight specializes in The Vertical Sleeve Gastrectomy (VSG), a surgery in which approximately 85% of the left side of the stomach is surgically removed resulting in considerable reduction of the food intake. The VSG requires stapling of the stomach and is a non-reversible procedure.
My name is Tracy Oliver and I had the vertical sleeve gastrectomy with Dr.Rodriguez in Juarez, Mexico on June 15th, 2011. I weighed 255 pounds and had a BMI of 42. It is now 7 months later and I now weight 162 pounds and my BMI is 27…I have lost about 92 pounds. I feel great now…I have lots of energy…I can eat just about anything I want to..just in small amounts. I live life again and I love it.
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