A García-Sesma1, J Calvo2, A Manrique2, F Cambra2, I Justo2, O Caso2, A Marcacuzco2, C Loinaz2, C Jiménez2. 1. HPB Surgery and Abdominal Organs Transplantation Unit, University Hospital Doce de Octubre, Madrid, Spain. Electronic address: agsesma@hotmail.com. 2. HPB Surgery and Abdominal Organs Transplantation Unit, University Hospital Doce de Octubre, Madrid, Spain.
Abstract
BACKGROUND: The prevalence of obesity has increased dramatically, even in the population awaiting a liver transplantation. Despite their associated complications, we cannot consider morbid obesity any longer as an absolute contraindication to liver transplantation. Dietary approaches alone are usually completely ineffective. Bariatric surgery is the gold-standard treatment for morbid obesity and can be performed before, during, or after transplantation. MATERIALS AND METHODS: At our Liver Transplantation Unit, a single surgeon performed a sleeve gastrectomy in 8 patients with liver cirrhosis due to nonalcoholic steatohepatitis, alcohol, or HCV. The Child score was A in 6 patients and B in the remaining 2 patients. Two of our patients had portal hypertension with mild esophageal varices. The procedure was performed laparoscopically in 7 cases (87.5%); in the other case, it was performed by open approach due to portal hypertension and according to patient preferences. RESULTS: Patients showed no postoperative morbidity or mortality. The mean postoperative body mass index of our patients was 37.4, 33.3, and 30.3 kg/m2 at 3, 6, and 12 months after surgery, respectively. The mean percentage excess weight loss of our patients was 42.9%, 62.2%, and 76.3% at 3, 6, and 12 months. Two of the patients have already undergone a successful liver transplant. CONCLUSION: Bariatric surgery in selected patients with compensated cirrhosis and without significative portal hypertension is reasonable. There are not clear guidelines on the use of bariatric surgery in patients with cirrhosis. In our experience, the sleeve gastrectomy is safe and effective in the treatment of patients with compensated cirrhosis; in a short time, the sleeve gastrectomy can improve candidacy in morbidly obese patients awaiting transplantation.
BACKGROUND: The prevalence of obesity has increased dramatically, even in the population awaiting a liver transplantation. Despite their associated complications, we cannot consider morbid obesity any longer as an absolute contraindication to liver transplantation. Dietary approaches alone are usually completely ineffective. Bariatric surgery is the gold-standard treatment for morbid obesity and can be performed before, during, or after transplantation. MATERIALS AND METHODS: At our Liver Transplantation Unit, a single surgeon performed a sleeve gastrectomy in 8 patients with liver cirrhosis due to nonalcoholic steatohepatitis, alcohol, or HCV. The Child score was A in 6 patients and B in the remaining 2 patients. Two of our patients had portal hypertension with mild esophageal varices. The procedure was performed laparoscopically in 7 cases (87.5%); in the other case, it was performed by open approach due to portal hypertension and according to patient preferences. RESULTS:Patients showed no postoperative morbidity or mortality. The mean postoperative body mass index of our patients was 37.4, 33.3, and 30.3 kg/m2 at 3, 6, and 12 months after surgery, respectively. The mean percentage excess weight loss of our patients was 42.9%, 62.2%, and 76.3% at 3, 6, and 12 months. Two of the patients have already undergone a successful liver transplant. CONCLUSION: Bariatric surgery in selected patients with compensated cirrhosis and without significative portal hypertension is reasonable. There are not clear guidelines on the use of bariatric surgery in patients with cirrhosis. In our experience, the sleeve gastrectomy is safe and effective in the treatment of patients with compensated cirrhosis; in a short time, the sleeve gastrectomy can improve candidacy in morbidly obesepatients awaiting transplantation.
Authors: Babak J Orandi; Joshua W Purvis; Robert M Cannon; A Blair Smith; Cora E Lewis; Norah A Terrault; Jayme E Locke Journal: Am J Surg Date: 2020-06-13 Impact factor: 2.565
Authors: Víctor Lopez-Lopez; Juan José Ruiz-Manzanera; Dilmurodjon Eshmuminov; Kuno Lehmann; Marcel Schneider; Markus von der Groeben; David Ruiz de Angulo; Ursula Gajownik; Jose Antonio Pons; Francisco Sánchez-Bueno; Ricardo Robles-Campos; Pablo Ramírez-Romero Journal: Obes Surg Date: 2020-11-23 Impact factor: 4.129
Authors: Sophia M-T Schmitz; Andreas Kroh; Alexander Koch; Jonathan F Brozat; Christine Stier; Ulf P Neumann; Tom F Ulmer; Patrick H Alizai Journal: Obes Surg Date: 2021-04-04 Impact factor: 4.129