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Liver damage in obese patients.
Antonio Del Gaudio1, Luca Boschi, Giovanni-Alberto Del Gaudio
1Department of Surgery, University of Bologna, S. Orsola Hospital, Via Massarenti, 9, I-40138 Bologna, Italy. delgaud@med.unibo.it
Obesity Surgery
|February 6, 2003
Summary
Morbidly obese patients frequently have liver damage, including steatosis and fibrosis, even with normal liver function tests. Obesity is an independent risk factor for liver disease, highlighting the need for liver assessment during bariatric surgery.
Area of Science:
- Hepatology
- Bariatric Surgery
- Obesity Medicine
Background:
- Nonalcoholic steatohepatitis and cirrhosis are common in obese individuals.
- Liver function tests may not detect underlying liver damage in obese patients.
- Transparietal liver biopsy is recommended for obese patients with altered hepatic function.
Purpose of the Study:
- To assess the liver condition of morbidly obese patients undergoing bariatric surgery.
- To evaluate hepatic steatosis, necroinflammatory activity, and fibrosis/cirrhosis via wedge liver biopsy.
- To prevent attributing surgical complications to pre-existing liver damage.
Main Methods:
- Prospective study of 216 consecutive morbidly obese patients.
- Preoperative liver function tests and wedge liver biopsy during vertical gastroplasty.
- Histological analysis for steatosis, necroinflammation, and fibrosis/cirrhosis.
Main Results:
- Abnormal liver function tests found in 65 patients (30.1%), 52 unexpectedly.
- Significant steatosis in 77.8% (168 patients).
- Necroinflammatory activity in 6.0% (13 patients); fibrosis in 21.3% (46 patients), including 2.3% (5 patients) with cirrhosis.
Conclusions:
- High incidence of histological liver damage in morbidly obese patients, irrespective of liver function tests.
- Obesity is an independent risk factor for liver damage and fibrosis.
- Identifying liver fibrosis/cirrhosis during surgery is crucial for prognosis and patient management.