OBES SURG DOI 10.1007/s11695-014-1486-5
ORIGINAL CONTRIBUTIONS
Laparoscopic Sleeve Gastrectomy Prevents the Deterioration of Renal Function in Morbidly Obese Patients Over 40 Years Jaime Ruiz-Tovar & Lorena Giner & Felipe Sarro-Sobrin & Maria Engracia Alsina & María Paz Marco & Lourdes Craver
# Springer Science+Business Media New York 2014
Abstract Background Chronic kidney disease (CKD) risk has been associated with elevated body mass index (BMI), especially in morbidly obese subjects. Aging and obesity can play a synergic effect on accelerating the renal function deterioration. Bariatric surgery (mainly gastric bypass or biliopancreatic diversion) has demonstrated an improvement on renal function, but little is known about the potential effect of sleeve gastrectomy on renal function. Methods A prospective observational study was performed. Between 2009 and 2013, 50 morbidly obese patients over 40 years underwent a laparoscopic sleeve gastrectomy (LSG) at our institution. Renal function was evaluated by serum creatinine, urea, and estimated glomerular filtration rate (eGFR), calculated using the MDRD-4 formula. All the variables were obtained at three times: on the first visit to the surgeon’s office (baseline), the day before surgery (preoperative), and 12 months after surgery. Results Fifty patients underwent a LSG, 44 females (88 %) and 6 males (12 %), with a mean age 49.2±6.4 years and mean BMI of 48.4±7.7 kg/m2. MDRD-4 values presented a significant reduction (69.4 ml/min/m2 at baseline vs 62.5 ml/ min/m2 preoperatively; CI95% (2.2–11.3 ml/min/m2); p= 0.01). Comparing pre- and postoperative values, a significant reduction could be determined in creatinine (0.89 mg/dl J. Ruiz-Tovar (*) : L. Giner Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain e-mail: [email protected] F. Sarro-Sobrin : M. P. Marco : L. Craver Department of Nephrology, University Hospital Arnau de Vilanova, Lérida, Spain M. E. Alsina Department of Radiology, General University Hospital Elche, Alicante, Spain
preoperatively vs 0.71 mg/dl postoperatively; p=0.01), urea (36.1 mg/dl preoperatively vs 29.8 mg/dl postoperatively; p= 0.023), and a significant increase in MDRD-4 (62.5 ml/min/ m 2 preoperatively vs 77.6 ml/min/m 2 postoperatively; p40 Kg/m2, or BMI >35 Kg/m2 with associated comorbidities, based on international guidelines. Time evolution of obesity should be at least of 5 years. Exclusion criterion was clinical history of previous kidney disease based on estimated glomerular filtration rate (eGFR) lower than 60 mL/min/1.73 m2.
Surgical Technique A longitudinal resection from the angle of His to approximately 3–4 cm orally to the pylorus was performed using a 40French bougie inserted along the lesser curve.
Variables Demographic and anthropometric data were recorded. Renal function was evaluated by serum creatinine, urea, and eGFR, calculated using the abbreviated modification of diet in renal disease (MDRD-4). All the variables were obtained at three times: on the first visit to the surgeon’s office and inclusion in the Bariatric Surgery Program (baseline), the day before surgery (preoperative), and 12 months after surgery (postoperative). The median interval time between inclusion in the Bariatric Surgery Program and the surgery was 14 months (range 12–15 months).
Statistical Analysis Statistical analysis was performed using SPSS version 19.0 (SPSS Inc., Chicago, IL). Results are expressed as mean± standard deviation or number and percentages. Paired t Student and ANOVA tests were used to compare baseline data with pre- and postoperative ones. A p value
ORIGINAL CONTRIBUTIONS
Laparoscopic Sleeve Gastrectomy Prevents the Deterioration of Renal Function in Morbidly Obese Patients Over 40 Years Jaime Ruiz-Tovar & Lorena Giner & Felipe Sarro-Sobrin & Maria Engracia Alsina & María Paz Marco & Lourdes Craver
# Springer Science+Business Media New York 2014
Abstract Background Chronic kidney disease (CKD) risk has been associated with elevated body mass index (BMI), especially in morbidly obese subjects. Aging and obesity can play a synergic effect on accelerating the renal function deterioration. Bariatric surgery (mainly gastric bypass or biliopancreatic diversion) has demonstrated an improvement on renal function, but little is known about the potential effect of sleeve gastrectomy on renal function. Methods A prospective observational study was performed. Between 2009 and 2013, 50 morbidly obese patients over 40 years underwent a laparoscopic sleeve gastrectomy (LSG) at our institution. Renal function was evaluated by serum creatinine, urea, and estimated glomerular filtration rate (eGFR), calculated using the MDRD-4 formula. All the variables were obtained at three times: on the first visit to the surgeon’s office (baseline), the day before surgery (preoperative), and 12 months after surgery. Results Fifty patients underwent a LSG, 44 females (88 %) and 6 males (12 %), with a mean age 49.2±6.4 years and mean BMI of 48.4±7.7 kg/m2. MDRD-4 values presented a significant reduction (69.4 ml/min/m2 at baseline vs 62.5 ml/ min/m2 preoperatively; CI95% (2.2–11.3 ml/min/m2); p= 0.01). Comparing pre- and postoperative values, a significant reduction could be determined in creatinine (0.89 mg/dl J. Ruiz-Tovar (*) : L. Giner Department of Surgery, Bariatric Surgery Unit, General University Hospital Elche, Alicante, Spain e-mail: [email protected] F. Sarro-Sobrin : M. P. Marco : L. Craver Department of Nephrology, University Hospital Arnau de Vilanova, Lérida, Spain M. E. Alsina Department of Radiology, General University Hospital Elche, Alicante, Spain
preoperatively vs 0.71 mg/dl postoperatively; p=0.01), urea (36.1 mg/dl preoperatively vs 29.8 mg/dl postoperatively; p= 0.023), and a significant increase in MDRD-4 (62.5 ml/min/ m 2 preoperatively vs 77.6 ml/min/m 2 postoperatively; p40 Kg/m2, or BMI >35 Kg/m2 with associated comorbidities, based on international guidelines. Time evolution of obesity should be at least of 5 years. Exclusion criterion was clinical history of previous kidney disease based on estimated glomerular filtration rate (eGFR) lower than 60 mL/min/1.73 m2.
Surgical Technique A longitudinal resection from the angle of His to approximately 3–4 cm orally to the pylorus was performed using a 40French bougie inserted along the lesser curve.
Variables Demographic and anthropometric data were recorded. Renal function was evaluated by serum creatinine, urea, and eGFR, calculated using the abbreviated modification of diet in renal disease (MDRD-4). All the variables were obtained at three times: on the first visit to the surgeon’s office and inclusion in the Bariatric Surgery Program (baseline), the day before surgery (preoperative), and 12 months after surgery (postoperative). The median interval time between inclusion in the Bariatric Surgery Program and the surgery was 14 months (range 12–15 months).
Statistical Analysis Statistical analysis was performed using SPSS version 19.0 (SPSS Inc., Chicago, IL). Results are expressed as mean± standard deviation or number and percentages. Paired t Student and ANOVA tests were used to compare baseline data with pre- and postoperative ones. A p value
