Effects of Liver Pathology on Sleeve Gastrectomy Outcomes

Sleeve gastrectomy engenders weight loss and improves comorbidities at 1 year postoperatively. A relationship has not been established between liver pathology and diabetic outcomes and weight loss following a sleeve gastrectomy. This study evaluates the association between liver pathology and both diabetic remission and weight loss in morbidly obese veterans. A prospective database of all patients undergoing sleeve gastrectomy with simultaneous liver biopsy at a Veterans Affairs Medical Center was analyzed from 2018 through 2020. The database included patient demographics, liver biopsy pathology, laboratory values, and antihyperglycemic medications. Patient outcomes at 12 months postoperatively were analyzed specifically for diabetic resolution and weight loss. Chi-square test and Fisher's exact test were used for categorical comparisons, and one-way analysis of variance test and two-tailed t-test were used for continuous variable comparisons. Multivariate linear regression models were created to assess the association between liver pathology and changes in body mass index (BMI) and diabetic status. A two-sided P-value of 0.05 indicated significance. Of the 77 patients included in the study, 70.1% of patients achieved diabetic remission at 12 months. After condensing steatosis and fibrosis scores into low- and high-grade categories, patients with no hepatic disease had significantly lower BMI at 12 months postoperatively than patients with low- or high-grade hepatic disease (29.2 ± 3.6 kg/m² versus 35.1 ± 4.0 kg/m² versus 34.5 ± 3.7 kg/m², respectively, P = .009). On multivariate linear regression model, low-grade overall hepatic disease (β = 3.1 ± 1.5; P = .043) and preoperative oral glycemic medications (β = 2.4 ± 1.0; P = .026) were associated with a significantly increased 12-month BMI. Also, Black or African American race compared with White race was associated with a significant decrease in postoperative BMI (β = -1.9 ± 0.8; P = .023). Regardless of preexisting liver disease, most diabetic patients who undergo sleeve gastrectomy experience diabetic remission at 12 months postoperatively. Additionally, patients with no underlying liver disease lose more weight than those with low- or high-grade liver disease.