Zubaidah Nor Hanipah1,2, Suriya Punchai1,3, Arthur McCullough4, Srinivasan Dasarathy4, Stacy A Brethauer1, Ali Aminian1, Philip R Schauer5. 1. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, M61, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. 2. Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia. 3. Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 4. Gastroenterology and Hepatology, Pathobiology and Transplantation Center, Clelveland Clinic, Cleveland, OH, USA. 5. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, M61, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. schauep@ccf.org.
Abstract
INTRODUCTION: Studies on bariatric patients with cirrhosis and portal hypertension are limited. The aim of this study was to review our experience in cirrhotic patients with portal hypertension who had bariatric surgery. METHOD: All cirrhotic patients with portal hypertension who underwent laparoscopic bariatric surgery, from 2007 to 2017, were retrospectively reviewed. RESULTS: Thirteen patients were included; eight (62%) were female. The median age was 54 years (interquartile range, IQR 49-60) and median BMI was 48 kg/m2 (IQR 43-55). Portal hypertension was diagnosed based on endoscopy (n = 5), imaging studies (n = 3), intraoperative increased collateral circulation (n = 2), and endoscopy and imaging studies (n = 3). The bariatric procedures included sleeve gastrectomy (n = 10, 77%) and Roux-en-Y gastric bypass (n = 3, 23%). The median length of hospital stay was 3 days (IQR 2-4). Three 30-day complications occurred including wound infection (n = 1), intra-abdominal hematoma (n = 1), and subcutaneous hematoma (n = 1). No intraoperative or 30-day mortalities. There were 11 patients (85%) at 1-year follow-up and 9 patients (69%) at 2-year follow-up. At 2 years, the median percentage of excess weight loss (EWL) and total weight loss (TWL) were 49 and 25%, respectively. There was significant improvement in diabetes (100%), dyslipidemia (100%), and hypertension (50%) at 2 years after surgery. CONCLUSION: Bariatric surgery in selected cirrhotic patients with portal hypertension is relatively safe and effective.
INTRODUCTION: Studies on bariatric patients with cirrhosis and portal hypertension are limited. The aim of this study was to review our experience in cirrhotic patients with portal hypertension who had bariatric surgery. METHOD: All cirrhotic patients with portal hypertension who underwent laparoscopic bariatric surgery, from 2007 to 2017, were retrospectively reviewed. RESULTS: Thirteen patients were included; eight (62%) were female. The median age was 54 years (interquartile range, IQR 49-60) and median BMI was 48 kg/m2 (IQR 43-55). Portal hypertension was diagnosed based on endoscopy (n = 5), imaging studies (n = 3), intraoperative increased collateral circulation (n = 2), and endoscopy and imaging studies (n = 3). The bariatric procedures included sleeve gastrectomy (n = 10, 77%) and Roux-en-Y gastric bypass (n = 3, 23%). The median length of hospital stay was 3 days (IQR 2-4). Three 30-day complications occurred including wound infection (n = 1), intra-abdominal hematoma (n = 1), and subcutaneous hematoma (n = 1). No intraoperative or 30-day mortalities. There were 11 patients (85%) at 1-year follow-up and 9 patients (69%) at 2-year follow-up. At 2 years, the median percentage of excess weight loss (EWL) and total weight loss (TWL) were 49 and 25%, respectively. There was significant improvement in diabetes (100%), dyslipidemia (100%), and hypertension (50%) at 2 years after surgery. CONCLUSION: Bariatric surgery in selected cirrhotic patients with portal hypertension is relatively safe and effective.
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