Safety and Efficacy of Bariatric Surgery in Patients with Cirrhosis

2018 ◽  
Author(s):  
Hideharu Shimizu ◽  
Tomasz G. Rogula ◽  
Philip R. Schauer
Keyword(s):  
Bariatric Surgery ◽  
Sleeve Gastrectomy ◽  
Metabolic Diseases ◽  
Bariatric Procedure ◽  
Morbidly Obese ◽  
Class A ◽  
Bariatric Patients ◽  
Pugh Class ◽  
Cirrhotic Patients ◽  
Perioperative Risks

Perioperative risks for morbidly obese patients with cirrhosis are significant, and surgeons should consider these risks carefully in deciding on the type of bariatric procedure to be performed. The benefits of bariatric surgery for cirrhotic patients include substantial weight loss, improvements in metabolic diseases, and potential regression of fibrosis, which can also increase their eligibility and candidacy for liver transplantation. There is currently a lack of strong evidence, but the restrictive bariatric procedures are the safest options for carefully selected patients with cirrhosis. Sleeve gastrectomy is likely the best bariatric procedure for obtaining good outcomes without a prohibitive complication rate or mortality for patients with compensated, Child-Pugh class A cirrhosis without portal hypertension. Roux-en-Y gastric bypass is also appropriate for patients who are not suitable for sleeve gastrectomy. Surgeons should be prepared in case they see bariatric patients with cirrhosis diagnosed preoperatively or intraoperatively.

scholarly journals GERD after Bariatric Surgery. Can We Expect Endoscopic Findings?

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 506
Author(s):  
Ramon Vilallonga ◽  
Sergi Sanchez-Cordero ◽  
Nicolas Umpiérrez Mayor ◽  
Alicia Molina ◽  
Arturo Cirera de Tudela ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Morbidly Obese ◽  
Review Of The Literature ◽  
Endoscopic Findings ◽  
Asymptomatic Patients ◽  
Bariatric Patients ◽  
Specific Care

Background and Objectives: Bariatric surgery remains the gold standard treatment for morbidly obese patients. Roux-en-y gastric bypass and laparoscopic sleeve gastrectomy are the most frequently performed surgeries worldwide. Obesity has also been related to gastroesophageal reflux disease (GERD). The management of a preoperative diagnosis of GERD, with/without hiatal hernia before bariatric surgery, is mandatory. Endoscopy can show abnormal findings that might influence the final type of surgery. The aim of this article is to discuss and review the evidence related to the endoscopic findings after bariatric surgery. Materials and Methods: A systematic review of the literature has been conducted, including all recent articles related to endoscopic findings after bariatric surgery. Our review of the literature has included 140 articles, of which, after final review, only eight were included. The polled articles included discussion of the endoscopy findings after roux-en-y gastric bypass and laparoscopic sleeve gastrectomy. Results: We found that the specific care of bariatric patients might include an endoscopic diagnosis when GERD symptoms are present. Conclusions: Recent evidence has shown that endoscopic follow-up after laparoscopic sleeve gastrectomy could be advisable, due to the pathological findings in endoscopic procedures in asymptomatic patients.

American Society for Metabolic and Bariatric Surgery updated position statement on sleeve gastrectomy as a bariatric procedure

2017 ◽  
Vol 13 (10) ◽  
pp. 1652-1657 ◽  
Author(s):  
Mohamed Ali ◽  
Maher El Chaar ◽  
Saber Ghiassi ◽  
Ann M. Rogers
Keyword(s):  
Bariatric Surgery ◽  
Sleeve Gastrectomy ◽  
Position Statement ◽  
Bariatric Procedure ◽  
American Society ◽  
Metabolic And Bariatric Surgery

scholarly journals Bariatric Surgery in Cirrhotic Patients: Is It Safe?

2019 ◽  
Vol 30 (4) ◽  
pp. 1241-1248 ◽  
Author(s):  
Hafsa Younus ◽  
Amit Sharma ◽  
Rosa Miquel ◽  
Alberto Quaglia ◽  
Subba Rao Kanchustambam ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Liver Disease ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Class Iii ◽  
Alcoholic Fatty Liver ◽  
Long Term Outcome ◽  
Bariatric Patients ◽  
Cirrhotic Patients

Abstract Introduction Ten percent of cirrhotic patients are known to have a high risk of postoperative complications. Ninety percent of bariatric patients suffer from non-alcoholic fatty liver disease (NAFLD), and 50% of them may develop non-alcoholic steatohepatitis (NASH) which can progress to cirrhosis. The aim of this study was to assess whether the presence of cirrhosis at the time of bariatric surgery is associated with an increased rate and severity of short- and long-term cirrhotic complications. Methods A cohort of 110 bariatric patients, between May 2003 and February 2018, who had undergone liver biopsy at the time of bariatric surgery were reassessed for histological outcome and divided into two groups based on the presence (C, n = 26) or absence (NC, n = 84) of cirrhosis. The NC group consisted of NASH (n = 49), NAFLD (n = 24) and non-NAFLD (n = 11) liver histology. Medical notes were retrospectively assessed for patient characteristics, development of 30-day postoperative complications, severity of complications (Clavien-Dindo (CD) classification) and length of stay. The C group was further assessed for long-term cirrhosis-related outcomes. Results The C group was older (52 years vs 43 years) and had lower BMI (46 kg/m2 vs 52 kg/m2) and weight (126 kg vs 145 kg) compared to the NC group (p < 0.05). The C group had significantly higher overall complication rate (10/26 vs 14/84, p < 0.05) and severity of complications (CD class ≥ III, 12% vs 7%, p < 0.05) when compared to the NC group. The length of stay was similar between the two groups (5 days vs 4 days). The C group had significant improvement in model end-stage liver disease scores (7 vs 6, p < 0.01) with median follow-up of 4.5 years (range 2–11 years). There were no long-term cirrhosis-related complications or mortality in our studied cohort (0/26). Conclusion Bariatric surgery in cirrhotic patients has a higher risk of immediate postoperative complications. Long-term cirrhosis-related complications or mortality was not increased in this small cohort. Preoperative identification of liver cirrhosis may be useful for risk stratification, optimisation and informed consent. Bariatric surgery in well-compensated cirrhotic patients may be used as an aid to improve long-term outcome.

scholarly journals Case Report of Increased Exposure to Antiretrovirals following Sleeve Gastrectomy

2020 ◽  
Vol 64 (4) ◽  
Author(s):  
Sarah Israel ◽  
Hila Elinav ◽  
Ram Elazary ◽  
Daniel Porat ◽  
Roni Gibori ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Sleeve Gastrectomy ◽  
Case Report ◽  
Therapeutic Drug Monitoring ◽  
Drug Exposure ◽  
Therapeutic Drug ◽  
Morbidly Obese ◽  
Limited Data ◽  
Time Points ◽  
Antiretroviral Drug

ABSTRACT Bariatric surgery is increasingly performed in morbidly obese HIV patients. Limited data exist regarding antiretroviral drug exposure after bariatric surgery. We report a case of a morbidly obese HIV patient who underwent sleeve gastrectomy. Abacavir, lamivudine, and dolutegravir therapeutic drug monitoring was performed at several time points pre- and postsurgery. Significantly increased levels were measured, particularly for abacavir, whose levels increased ∼12-fold. Several mechanistic explanations for these findings are discussed.

Laparoscopic Sleeve Gastrectomy: Standardized Technique of a Potential Stand-alone Bariatric Procedure in Morbidly Obese Patients

2008 ◽  
Vol 32 (7) ◽  
pp. 1462-1465 ◽  
Author(s):  
Markus A. Kueper ◽  
Klaus M. Kramer ◽  
Andreas Kirschniak ◽  
Alfred Königsrainer ◽  
Rudolph Pointner ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Laparoscopic Sleeve Gastrectomy ◽  
Bariatric Procedure ◽  
Morbidly Obese ◽  
Obese Patients

scholarly journals Role Of Neo-Adjuvant TIPS in Child Pugh Class A And B Cirrhotic Patients Undergoing Elective Intra-Abdominal Surgery

2019 ◽  
Vol 8 (3) ◽  
pp. 2886-2890
Author(s):  
Deepanshu Jain ◽  
◽  
Maria Veronica Bandres ◽  
Ejaz Mahmood ◽  
Eyob Feyssa
Keyword(s):  
Abdominal Surgery ◽  
Class A ◽  
Pugh Class ◽  
Cirrhotic Patients

scholarly journals Correlation between Hepatic Vein Wave form Changes on Doppler Ultrasound and the Severity of Diseases in Cirrhotic Patients

2021 ◽  
Vol 22 (2) ◽  
pp. 100-106
Author(s):  
Tarana Yasmin ◽  
Sohely Sultana ◽  
Mahmuda Nusrat Ima ◽  
Md Quamrul Islam ◽  
Shyamal Kumar Roy ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Doppler Ultrasound ◽  
Hepatic Vein ◽  
Wave Form ◽  
Venous Blood Flow ◽  
Class A ◽  
Class B ◽  
Pugh Class ◽  
Cirrhotic Patients ◽  
Class C

Background: Cirrhosis is a common problem and is a leading cause of chronic liver disease. Early diagnosis with assessment of severity of diseases may help prevent the associated complications and patients’ sufferings. Now a days Hepatic venous Doppler can be a tool for diagnosis of cirrhosis and to assess correlation between waveform changes and severity of diseases. Objective: The purposes of this study was to determine the significance of hepatic vein waveform changes on doppler ultrasound in cirrhotic patients and to correlate with liver dysfunction. Materials and methods: This study was carried out in the department of Radiology and Imaging of Enam Medical College and Hospital during January 2017 to May 2018. Doppler waveforms were obtained from right hepatic vein in all the cases and classified as triphasic, biphasic and monophasic. Waveform comparisons were made among patients with differing grades of cirrhosis. Child- Pugh class was used to assess severity of cirrhosis. Doppler sonography was done in 80 patients suspecting of having liver cirrhosis. Data on clinical findings, B mode sonographic findings and hepatic vein doppler ultrasound findings were collected and documented in structured forms. Analysis was done using SPSS - 20. Results: Total of 80 patients who met the inclusion criteria are included in the study with mean age of 45.37±7.64 (range 25-75) years. Among these 57 (71%) were males while 23(29%) were females. On the basis of hepatic function 25 (31%) patients presented in Child-Pugh Class A, 31(39%) with Class B and 24(30%) patients had Class C. Hepatic venous waveform was triphasic in 22 (27.5%), biphasic in 28(35%), and monophasic in 30 (37.5%) cases. Our study revealed 88% (21) of Child- Pugh Class C, 23% (7) of Class B and 8% (2) of class A patients had monophasic HV waveform. The hepatic venous waveform progressively changed from triphasic to biphasic to monophasic with advancing grade of cirrhosis. The relationship of these waveforms change had significant relation with hepatic dysfunction (p < 0.022). Conclusion: Hepatic vein wave form changes reflects the change in hepatic circulation associated with progression of liver cirrhosis. It can be used as a new parameter in the assessment of severity of liver cirrhosis. Thus, alteration in hepatic venous blood flow pattern on doppler ultrasound can be a useful noninvasive tool for evaluating diseases severity in patients with cirrhosis. J MEDICINE 2021; 22: 100-106

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