Laura Pestana1, James Swain2, Ross Dierkhising3, Michael L Kendrick2, Patrick S Kamath4, Kymberly D Watt5. 1. Department of Internal Medicine, Mayo Clinic, Rochester, MN. 2. Department of Surgery, Mayo Clinic, Rochester, MN. 3. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. 4. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. 5. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. Electronic address: watt.kymberly@mayo.edu.
Abstract
OBJECTIVE: To assess safety and outcomes (metabolic and liver) of bariatric surgery in patients with cirrhosis with or without portal hypertension. PATIENTS AND METHODS: This study is a retrospective review of 14 patients with Child's A cirrhosis with or without portal hypertension who were prospectively enrolled from February 23, 2009, through November 9, 2011, with 6- to 24-month follow-up after bariatric surgery (11 patients underwent sleeve gastrectomy [78.6%] and 3 gastric bypass [21.4%]). Four patients had portal hypertension detected by esophagogastroduodenoscopy. RESULTS: The mean patient age was 55.5 years, and 10 of 14 patients were women. The mean weight decreased from 125±18 to 94±17 at 1 year (P<.001) and 93±17 kg at 2 years (P<.001) postsurgery. The prevalence of diabetes decreased from 10 of 14 patients to 4 of 12 (P=.01) and 1 of 6 (P=.02) at 1 and 2 years postsurgery. The frequency of dyslipidemia and hypertension decreased but was not statistically significant; however, the number of medications required to control them decreased. Hepatic steatosis was detected by perioperative liver biopsy in 13 of 14 patients (5%-30% steatosis in 6 patients, 31%-60% in 6, and >60% in 1). At 1 year postsurgery, only 1 of 8 patients who underwent follow-up ultrasound imaging showed evidence of steatosis. The bilirubin level was above 2 mg/dL in 1 patient at 1 year postsurgery. One patient had encephalopathy at 2 years postsurgery. None of the patients developed peri- or postoperative bleeding or surgical complications. CONCLUSION: Bariatric surgery in patients with compensated cirrhosis even with mild portal hypertension is well tolerated and safe with minimal risk of postoperative complications if performed in a large referral center. This population can experience the beneficial effects of weight loss and improved metabolic syndrome, as well as reduced hepatic steatosis.
OBJECTIVE: To assess safety and outcomes (metabolic and liver) of bariatric surgery in patients with cirrhosis with or without portal hypertension. PATIENTS AND METHODS: This study is a retrospective review of 14 patients with Child's A cirrhosis with or without portal hypertension who were prospectively enrolled from February 23, 2009, through November 9, 2011, with 6- to 24-month follow-up after bariatric surgery (11 patients underwent sleeve gastrectomy [78.6%] and 3 gastric bypass [21.4%]). Four patients had portal hypertension detected by esophagogastroduodenoscopy. RESULTS: The mean patient age was 55.5 years, and 10 of 14 patients were women. The mean weight decreased from 125±18 to 94±17 at 1 year (P<.001) and 93±17 kg at 2 years (P<.001) postsurgery. The prevalence of diabetes decreased from 10 of 14 patients to 4 of 12 (P=.01) and 1 of 6 (P=.02) at 1 and 2 years postsurgery. The frequency of dyslipidemia and hypertension decreased but was not statistically significant; however, the number of medications required to control them decreased. Hepatic steatosis was detected by perioperative liver biopsy in 13 of 14 patients (5%-30% steatosis in 6 patients, 31%-60% in 6, and >60% in 1). At 1 year postsurgery, only 1 of 8 patients who underwent follow-up ultrasound imaging showed evidence of steatosis. The bilirubin level was above 2 mg/dL in 1 patient at 1 year postsurgery. One patient had encephalopathy at 2 years postsurgery. None of the patients developed peri- or postoperative bleeding or surgical complications. CONCLUSION: Bariatric surgery in patients with compensated cirrhosis even with mild portal hypertension is well tolerated and safe with minimal risk of postoperative complications if performed in a large referral center. This population can experience the beneficial effects of weight loss and improved metabolic syndrome, as well as reduced hepatic steatosis.
Authors: Inka Miñambres; Miguel Angel Rubio; Ana de Hollanda; Irene Breton; Nuria Vilarrasa; Silvia Pellitero; Marta Bueno; Albert Lecube; Clara Marcuello; Albert Goday; Maria D Ballesteros; German Soriano; Assumpta Caixàs Journal: Obes Surg Date: 2019-02 Impact factor: 4.129