Nonalcoholic Fatty Liver Disease and Bariatric Surgery

Sindu Stephen; Ancha Baranova; Zobair M Younossi

Disclosures

Expert Rev Gastroenterol Hepatol. 2012;6(2):163-171. 

In This Article

Bariatric Surgery in Patients With Cirrhosis

Cirrhosis is often discovered incidentally during bariatric surgery. Few studies have addressed the risk of bariatric surgery in cirrhotic patients. A retrospective review of laparoscopic surgeries in 50 cirrhotic patients revealed no deaths and a mean length of postoperative stay of 3 days. This study included only one RYGB.[63] Takata et al. reviewed eight cirrhotic patients undergoing laparoscopic SG in which no deaths occurred.[64] Dallal et al. analyzed 30 patients with Child–Pugh class A cirrhosis undergoing laparoscopic RYGB (n = 27) and laparoscopic sleeve gastrectomies (n = 3). A third of patients developed complications extending hospital stay but no mortality was noted.[65] Recently, Mosko et al. performed a large population-based study assessing outcomes of bariatic surgery in patients with cirrhosis.[66] Patients without cirrhosis had lower mortality rates compared with compensated and decompensated cirrhosis (0.3 vs 0.9 and 16.3%, respectively; p = 0.0002). The average length of stay was longer for patients with decompensated and compensated cirrhosis compared with patients without liver disease.[66] On average, centers performing more than 100 surgeries per year had low mortality rates, particularly compared with those performing fewer than 50 surgeries per year (0.2 vs 0.7%; p < 0.0001). The data stress that the choice of bariatric surgery in patients with cirrhosis should be considered only after ensuring that the liver disease is well compensated and no evidence of portal hypertension exists.

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