Bariatric surgery in liver cirrhosis
Obesity is frequently associated with its hepatic manifestation, the nonalcoholic fatty liver disease (NAFLD). The most effective treatment for morbid obesity is bariatric surgery (BS) also improving NAFLD and liver function. In patients where NAFLD has already progressed to liver cirrhosis, BS can...
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| Published in: | Frontiers in surgery Vol. 9; p. 986297 |
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| Main Authors: | , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Switzerland
Frontiers Media S.A
15-12-2022
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Obesity is frequently associated with its hepatic manifestation, the nonalcoholic fatty liver disease (NAFLD). The most effective treatment for morbid obesity is bariatric surgery (BS) also improving NAFLD and liver function. In patients where NAFLD has already progressed to liver cirrhosis, BS can be considered a high-risk procedure. Hence, consideration of the procedure and the most appropriate timing is crucial.
Obese patients suffering from NAFLD who underwent BS from two German University Medical Centers were retrospectively analyzed.
Twenty-seven patients underwent BS. Most common procedures were laparoscopic Roux-en-Y-gastric (RYGB) and laparoscopic sleeve gastrectomy (SG). All patients suffered from liver cirrhosis Child A. A preoperative transjugular portosystemic shunt (TIPS) was established in three patients and failed in another patient. Postoperative complications consisted of wound healing disorders (
= 2), anastomotic bleeding (
= 1), and leak from the staple line (
= 1). This patient suffered from intraoperatively detected macroscopic liver cirrhosis. Excess weight loss was 73% and 85% after 1 and 2 years, respectively. Two patients suffered from postoperative aggravation of their liver function, resulting in a higher Child-Pugh score, while three could be removed from the waiting list for a liver transplantation.
BS leads to weight loss, both after SG and RYGB, and potential improvement of liver function in liver cirrhosis. These patients need to be considered with care when evaluated for BS. Preoperative TIPS implantation may reduce the perioperative risk in selected patients. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 These authors share senior authorship Edited by: Daniel Gero, University Hospital Zurich, Switzerland Abbreviations BMI, body mass index; BS, bariatric surgery; BW, body weight; COPD, chronic obstructive pulmonary disease; EGB, extended gastric Roux-Y-bypass; EWL, excess weight loss; GB, gastric band; GERD, gastroesophageal reflux disease; HCC, hepatocellular carcinoma; HVPG, hepatic venous pressure gradient; IFSO, international federation of the surgery of obesity and metabolic disorders; LOS, length of stay; LT, liver transplantation; MELD, model of end stage liver disease; MES, metabolic syndrome; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatosis hepatis; RYGB, Roux-en–Y-gastric bypass; SG, sleeve gastrectomy; SPSS, Statistical Package for Social Sciences; SD, standard deviation; TIPS, transjugular portosystemic shunt; Y, years Reviewed by: Michael Ardelt, Friedrich Schiller University Jena, Germany Mario Musella, Federico II University Hospital, Italy Frederik Berrevoet, Ghent University Hospital, Belgium These authors share first authorship Specialty Section: This article was submitted to Visceral Surgery, a section of the journal Frontiers in Surgery |
| ISSN: | 2296-875X 2296-875X |
| DOI: | 10.3389/fsurg.2022.986297 |