Bariatric surgery in liver cirrhosis

被引:7
作者
Mehdorn, A. S. [1 ]
Moulla, Y. [2 ]
Mehdorn, M. [2 ]
Dietrich, A. [2 ]
Schoenfels, W. [1 ]
Becker, T. [1 ]
Braun, F. [1 ]
Beckmann, J. H. [1 ]
Linecker, M. [1 ]
机构
[1] Univ Hosp Schleswig Holstein Campus Kiel, Dept Gen Visceral Thorac Transplantat & Pediat Su, Kiel, Germany
[2] Univ Hosp Leipzig, Dept Visceral Transplant Thorac & Vasc Surg, Leipzig, Germany
来源
FRONTIERS IN SURGERY | 2022年 / 9卷
关键词
bariatric surgery; sleeve gastrectomy; obesity; obese patients; liver cirrhosis; NAFLD; Roux-en-Y-gastric bypass; liver failure; Y GASTRIC BYPASS; SLEEVE GASTRECTOMY; TRANSPLANTATION; DISEASE; OBESITY;
D O I
10.3389/fsurg.2022.986297
中图分类号
R61 [外科手术学];
学科分类号
摘要
IntroductionObesity is frequently associated with its hepatic manifestation, the nonalcoholic fatty liver disease (NAFLD). The most effective treatment for morbid obesity is bariatric surgery (BS) also improving NAFLD and liver function. In patients where NAFLD has already progressed to liver cirrhosis, BS can be considered a high-risk procedure. Hence, consideration of the procedure and the most appropriate timing is crucial. Material and MethodsObese patients suffering from NAFLD who underwent BS from two German University Medical Centers were retrospectively analyzed. ResultsTwenty-seven patients underwent BS. Most common procedures were laparoscopic Roux-en-Y-gastric (RYGB) and laparoscopic sleeve gastrectomy (SG). All patients suffered from liver cirrhosis Child A. A preoperative transjugular portosystemic shunt (TIPS) was established in three patients and failed in another patient. Postoperative complications consisted of wound healing disorders (n = 2), anastomotic bleeding (n = 1), and leak from the staple line (n = 1). This patient suffered from intraoperatively detected macroscopic liver cirrhosis. Excess weight loss was 73% and 85% after 1 and 2 years, respectively. Two patients suffered from postoperative aggravation of their liver function, resulting in a higher Child-Pugh score, while three could be removed from the waiting list for a liver transplantation. ConclusionBS leads to weight loss, both after SG and RYGB, and potential improvement of liver function in liver cirrhosis. These patients need to be considered with care when evaluated for BS. Preoperative TIPS implantation may reduce the perioperative risk in selected patients.
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页数:8
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