Major surgery in patients undergoing hemodialysis.

This report describes our experience with major surgery in hemodialysis patients and discusses special considerations in their surgical management. A total of 359 operations under general anesthesia excluding blood access operations were performed in hemodialysis patients (kidney transplantation, 168; bilateral nephrectomy with or without splenectomy, 38; graftectomy. 40; parathyroidectomy. 43; mastectomy. 2; gastrectomy. 24; biliary tract surgery, 9; surgery of intestinal obstruction, 2; appendectomy, 8; surgery of colon & rectum, 10; haemorrhoidectomy, 5; etc.). There were six postoperative deaths within 30 days (cadaveric kidney transplant, I; graftectomy, 3; pancreaticoduodenectomy, I; subtotal gastrectomy, I). Recently. cadaveric kidney transplants are increasing and HLA-DR matching in cadaveric transplant has gained acceptance. The introduction of Cyclosporin A has remarkably improved the graft survival rate so far. Splenectomy has resulted in a significant improvement in the hematologic status of all patients. Bilaterally excised kidneys for a pretransplant procedure or because of severe hypertension decrease in weight progressively after the start of hemodialysis. Since the pathogenesis of renal osteodystrophy is highly complex. image diagnosis of parathyroid glands is valuable for (I) definite diagnosis of secondary hyperparathyroidism, (2) localization, and (3) diagnosis for effectiveness of conservative treatment. Fourteen of 18 patients with cancer (thyroid, I; breast. 2; stomach, 4; bile duct, I; head of pancreas, I; colon & rectum, 8; kidney, I) underwent curative surgery. Although hemodialysis patients remain chronically ill despite optimal hemodialysis, they tolerate major emergency or elective surgery rather well if the necessary precautions are taken.