Bariatric surgery in liver cirrhosis

Area of Science:

• Hepatology
• Bariatric Surgery
• Obesity Medicine

Background:

• Nonalcoholic fatty liver disease (NAFLD) is a common hepatic manifestation of obesity.
• Bariatric surgery (BS) is effective for morbid obesity and can improve NAFLD and liver function.
• BS in patients with advanced NAFLD (liver cirrhosis) is considered high-risk, necessitating careful consideration of timing and procedure.

Purpose of the Study:

• To evaluate the safety and efficacy of bariatric surgery in obese patients with liver cirrhosis (Child A).
• To assess postoperative complications and outcomes, including weight loss and liver function.
• To determine the role of preoperative transjugular portosystemic shunt (TIPS) in mitigating perioperative risks.

Main Methods:

• Retrospective analysis of 27 obese patients with NAFLD and liver cirrhosis (Child A) who underwent bariatric surgery (RYGB or SG).
• Evaluation of preoperative TIPS implantation in selected patients.
• Assessment of postoperative complications, excess weight loss (EWL), and liver function (Child-Pugh score).

Main Results:

• Common procedures included Roux-en-Y-gastric bypass (RYGB) and sleeve gastrectomy (SG).
• Postoperative complications were generally low, including wound healing disorders, anastomotic bleeding, and staple line leak.
• Excess weight loss was significant (73% at 1 year, 85% at 2 years).
• Two patients experienced temporary liver function decline, while three were removed from the liver transplant waiting list.

Conclusions:

• Bariatric surgery effectively promotes weight loss and can improve liver function in patients with liver cirrhosis.
• Careful patient selection and evaluation are crucial for BS in this high-risk group.
• Preoperative TIPS may be beneficial in selected cirrhotic patients undergoing BS to reduce perioperative risks.