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Bariatric Surgery in Cirrhotic Patients: a Matched Case-Control Study
Nicolás Quezada1, Gregorio Maturana2, María Jesús Irarrázaval2
1Department of Digestive Surgery, Upper Gastrointestinal and Hernia surgery division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, 362 Diagonal Paraguay, 4th Floor - Office 410, Santiago, Región Metropolitana, Chile. nfquezada@gmail.com.
Laparoscopic bariatric surgery (LBS) offers effective weight loss and comorbidity resolution for patients with Child A liver cirrhosis. However, LBS in this population is associated with a significantly higher risk of complications compared to patients without cirrhosis.
Area of Science:
- Bariatric Surgery
- Hepatology
- Gastroenterology
Background:
- Laparoscopic bariatric surgery (LBS) shows promise in improving organ function and symptoms for patients with end-stage liver disease.
- While LBS demonstrates good weight loss outcomes in patients with cirrhosis, concerns exist regarding increased complication risks.
- Existing literature primarily comprises clinical series, necessitating comparative studies.
Purpose of the Study:
- To compare the outcomes of LBS, predominantly laparoscopic gastric bypass, between patients with and without cirrhosis.
- To evaluate differences in weight loss, comorbidity resolution, and complication rates.
Main Methods:
- A retrospective 1:3 matched case-control study was conducted.
- Included were bariatric patients with Child A cirrhosis and a control group without cirrhosis.
- Data analyzed included demographics, operative variables, postoperative complications, long-term weight loss, and comorbidity resolution.
Main Results:
- The study included 16 patients with cirrhosis (PC) and 48 controls. Mean age was 50 years, with a preoperative BMI of 39 kg/m².
- The PC group experienced higher rates of overall (31% vs. 6%) and severe (13% vs. 0%) complications.
- Mean %EWL at 2 years was comparable (84.9% in PC vs. 83.1% in controls), but comorbidity remission differed, notably for hypertension (14% vs. 65%).
Conclusions:
- LBS is effective for weight loss and comorbidity management in obese patients with Child A liver cirrhosis.
- However, LBS in this patient group is associated with a significantly elevated risk of complications.
- Careful patient selection and risk assessment are crucial for LBS in cirrhotic patients.
