Laparoscopic Sleeve Gastrectomy Resolves NAFLD: Another Formal Indication for Bariatric Surgery?

IntroductionObesity is strongly associated with non-alcoholic fatty liver disease (NAFLD); 66-99% of the obese population could suffer some grade of NAFLD. It can progress into cirrhosis, which is associated to hepatocellular carcinoma, and a liver transplant could be indicated. NAFLD represents the third cause of liver transplant, and it is expected to be the first by 2025. Sleeve gastrectomy (SG) is the most common bariatric procedure over the world. There is scant literature regarding NAFLD after SG, and there are no prospective studies published up to date.ObjectiveTo evaluate the evolution of NAFLD in patients with obesity after 1year of SG.MethodsFrom January 2009 to December 2013, intraoperative liver biopsy was performed in 63 obese patients who underwent SG. Forty-three patients were again biopsied 1year after surgery. Demographics, body mass index, percentage of excess weight loss, liver function test, lipid panel, glucose panel, and histological changes were prospectively analyzed.ResultsOne hundred percent of the patients reversed or reduced the stage of steatosis or steatohepatitis 12months after surgery, obtaining a statistically significant difference for both steatosis and steatohepatitis. One patient presented complete cirrhosis regression in the pathology. Neither of the patients had worsened liver histology.ConclusionsNAFLD could be dealt with laparoscopic sleeve gastrectomy, preventing its progression into cirrhosis. SG can be performed in patients with obesity and metabolic syndrome, with NAFLD showing satisfactory results 12months after surgery. NAFLD should be a formal indication for bariatric surgery.