Tarun Mittal1, Anmol Ahuja2, Ashish Dey2, Vinod K Malik2, Mohammad Taha Mustafa Sheikh2, Naresh Kumar Bansal3, Harish Kanuri2. 1. Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India. tarunmittalmas@gmail.com. 2. Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India. 3. Institute of Liver Gastroenterology and Hepatobiliary Sciences, Sir Ganga Ram Hospital, Old Rajender Nagar, New Delhi, 110060, India.
Abstract
INTRODUCTION: Advanced liver disease and portal hypertension (PH) are seen as a relative contraindication for bariatric and metabolic surgery. Several studies have shown significant improvement in liver function and liver histology after bariatric surgery. There are very few studies describing bariatric surgery in patients with PH. The purpose of this retrospective study is to evaluate the feasibility and results of laparoscopic sleeve gastrectomy (SG) in patients with PH. MATERIAL AND METHODS: We present our experience of performing laparoscopic SG in 15 patients with evidence of PH. All the patients were Childs Pugh Criteria A. PH was confirmed by the presence of dilated esophageal varices on endoscopy. RESULTS: The mean operative time was 77.33 ± 15.22 min and mean blood loss was 80.67 ± 37.12 ml. The mean length of stay was 2.73 ± 0.59 days. There were no intraoperative or immediate postoperative complications. None of the patients required blood transfusion in the postoperative period. The weight, BMI, Excess body weight loss% (EBWL%), Total weight loss (TWL) and TWL% at 1 year were 86.05 ± 14.40 kg, 31.16 kg/m2 ± 3.82, 63.84% ± 15.24, 31.49 ± 9.54 kg and 26.50 ± 5.42%, respectively. Diabetes and hypertension resolution at 1 year was 80% and 72.72%, respectively. All the patients were followed up for mean 3 ± 1.5 years. There were no immediate or long-term morbidity and mortality noted. CONCLUSION: SG is a feasible and safe option for the treatment of obesity in carefully selected patients with PH with good weight loss and comorbidity resolution.
INTRODUCTION: Advanced liver disease and portal hypertension (PH) are seen as a relative contraindication for bariatric and metabolic surgery. Several studies have shown significant improvement in liver function and liver histology after bariatric surgery. There are very few studies describing bariatric surgery in patients with PH. The purpose of this retrospective study is to evaluate the feasibility and results of laparoscopic sleeve gastrectomy (SG) in patients with PH. MATERIAL AND METHODS: We present our experience of performing laparoscopic SG in 15 patients with evidence of PH. All the patients were Childs Pugh Criteria A. PH was confirmed by the presence of dilated esophageal varices on endoscopy. RESULTS: The mean operative time was 77.33 ± 15.22 min and mean blood loss was 80.67 ± 37.12 ml. The mean length of stay was 2.73 ± 0.59 days. There were no intraoperative or immediate postoperative complications. None of the patients required blood transfusion in the postoperative period. The weight, BMI, Excess body weight loss% (EBWL%), Total weight loss (TWL) and TWL% at 1 year were 86.05 ± 14.40 kg, 31.16 kg/m2 ± 3.82, 63.84% ± 15.24, 31.49 ± 9.54 kg and 26.50 ± 5.42%, respectively. Diabetes and hypertension resolution at 1 year was 80% and 72.72%, respectively. All the patients were followed up for mean 3 ± 1.5 years. There were no immediate or long-term morbidity and mortality noted. CONCLUSION: SG is a feasible and safe option for the treatment of obesity in carefully selected patients with PH with good weight loss and comorbidity resolution.
Keywords:
Body mass index (BMI); Chronic Liver Disease (CLD); Laparoscopic Sleeve Gastrectomy (SG); Percentage Excess weight loss (%EWL); Portal Hypertension (PH); Roux-En-Y Gastric Bypass (RYGB); Total weight loss (TWL); Type 2 diabetes mellitus (T2DM)
Authors: Mohamed Abdalla Salman; Ahmed Abdallah Salman; Haitham S E Omar; Ahmed Abdelsalam; Mohamed Saber Mostafa; Mohamed Tourky; Ahmed Abd El Aal Sultan; Mohammed Hassan Elshafey; Walid Rafat Abdelaty; Abdoh Salem; Osama Osman Khaliel; Hossam E Elshafey; Mohamed Atallah; Hossam El-Din Shaaban; Mohamed Yousef; Mohammed A Nafea Journal: Surg Endosc Date: 2020-06-16 Impact factor: 4.584
Authors: J F Silverman; K F O'Brien; S Long; N Leggett; P G Khazanie; W J Pories; H T Norris; J F Caro Journal: Am J Gastroenterol Date: 1990-10 Impact factor: 10.864