Case Study: Transfusion-Free Bariatric (Obesity) Surgery
For individuals who are more than 100 pounds overweight, every day life can be a struggle. USC’s Bariatric Program offers new hope to those whose weight has become a life-threatening situation.
The program, led by Gary Anthone, M.D., is a medical and surgical weight loss program designed for individuals who are morbidly obese–more than 100 pounds above their ideal weight–or who have complicating conditions such as hypertension or diabetes.
Patients in the program undergo a surgery known as Distal Gastric Bypass. The procedure reduces the size of a patient’s stomach and adjusts the digestive track in order to decrease food intake and limit food absorption.
“In general, we expect patients to lose about 70 percent of their excess body weight in a year and a half after surgery,” said Dr. Anthone. “Patients have the support of nurses, endocrinologists, psychologists and others who will help them on their journey to a healthy weight.”
This surgery, like many others at USC, can be performed transfusion-free.
The first case study is a 53-year-old female who is 5 feet, 2 inches tall and weighed 311 lbs. She was admitted to USC University Hospital on Nov. 13, 1998 for a high gastric bypass procedure. Her body mass index was 57, which is classified as super morbid obesity. Her ideal body weight was l25 lbs. She had tried other weight loss methods to no avail. She also had severe orthopedic problems that limited her ability to walk and would eventually require spinal fusion-another factor contributing to her need for surgery.
Her history and exam revealed several co-morbidities such as insulin-dependent diabetes, high cholesterol and gastroesophageal reflux disease (GERD) symptoms.
On the day of admission her preoperative blood counts were: hemoglobin-12.6 and hematocrit 36.8, which suggests some mild anemia. Four days prior to discharge hemoglobin was 10.4 and hematocrit was 30-5.
Adding to the difficulty of transfusion-free surgery were extensive adhesions (scar tissue) from prior surgeries. Adhesions tend to bleed easily, which make controlling blood loss more challenging. However, the estimated blood loss was less than 400 cc’s. The non-blood management strategies used were primarily fluid management. The anesthesiologists used approximately 3,000cc’s of crystalloid (saline solution), 1,000cc’s of hespan and 500cc’s of albumin (a plasma protein fraction).
The second patient is a 50-year-old female who is 5 feet, 3 inches tall and weighed 291 lbs, She had a body mass index of 52–also classified as super morbid obesity. She was admitted to the hospital on Feb. 5, 1999 for a revision of prior gastric anastomosis (stomach stapling).
This patient suffered from hypertension, hyperlipidemia and sleep apnea. She also had a history of pulmonary embolisms and GERD symptoms. Her blood counts were within fairly normal ranges. Her preoperative hemoglobin and hematocrit were 13.4 and 40.0 respectively, which is in the normal range.
The estimated intraoperative blood loss was 350cc’s. Crystalloid and albumin were administered as needed to replace fluid volume. She was also given injections of erythropoeitin to correct her anemia.
The patient’s Durable Power of Attorney for Health Care allowed for the use of erythropoeitin (a medication to stimulate the production of red blood cells), albumin, intraoperative and postoperative blood salvage and hemodilution, if necessary.
A free USC University Hospital video that describes the procedure in detail and provides patient testimonials is available. For a free copy, please call 1-800-USC-CARE.