Long-Term Outcomes of Liver Pathology Following a Sleeve Gastrectomy

Introduction: The rising prevalence of obesity in the United States is paralleled by an increase in type II diabetes (T2D) and metabolic-associated steatotic liver disease. While lifestyle changes often do not afford sustainable weight loss, bariatric surgery, particularly sleeve gastrectomy (SG), offers a durable solution. This study investigates long-term outcomes in Veterans who underwent SG with concurrent liver biopsy. Methods: All patients undergoing SG with a liver biopsy from January 2018 to March 2021 were included. Baseline demographics and comorbidities included age, gender, race, preoperative BMI, hemoglobin A1c (HgbA1c), T2D, hypertension (HTN), gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), and presence of steatosis and fibrosis. Patients were followed postoperatively at 1, 3, and 5 years. Patient demographics and comorbidities were stratified by liver scores and compared pre- and postoperatively. A paired t-test compared variables. Multivariate linear regression assessed associations between liver pathology and BMI. Multivariate logistic regression analyzed associations between comorbidities and liver pathology. A P < .05 was significant. Results: A total of 95 patients underwent a laparoscopic SG with a liver biopsy. There was a level of steatosis (81%) or fibrosis (76.8%) in the majority of biopsies. For the entire cohort, there was a significant BMI reduction from baseline (40.6 ± 3.0 kg/m²) at 1, 3, and 5 years (33.9 ± 4.2, 35.0 ± 4.6, 34.7 ± 4.9 kg/m²; P < .001). At 5 years, % total weight loss (TWL) for no, low, and high liver scores was 18.3 ± 7.5, 13.5 ± 1.6, and 13.7 ± 2.5(P = .82). At 5 years postoperatively, there were significant reductions in mean HgbA1c level (6.2 versus 5.7, P < .001), T2D (47.4% versus 36.8%, P < .001), HTN (56.8% versus 39.0%, P < .001), GERD (49.5% versus 31.6%, P < .001), and OSA (66.3% versus 42.1%, P < .001). There was no significant difference in any postoperative comorbidity, BMI, or %TWL based on pathological liver scores (P > .05). Conclusion: This study underscores the long-term efficacy of SG in a predominantly African American Veteran cohort, irrespective of liver pathology. These results advocate for bariatric surgery to treat obese patients with liver disease, and even those with advanced hepatic conditions can achieve substantial health benefits.