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01-12-2020 | Dyslipidemia | Original Contributions

Bariatric Surgery in Cirrhotic Patients: a Matched Case-Control Study

Authors: Nicolás Quezada, Gregorio Maturana, María Jesús Irarrázaval, Rodrigo Muñoz, Sebastián Morales, Pablo Achurra, Cristóbal Azócar, Fernando Crovari

Published in: Obesity Surgery | Issue 12/2020

Abstract

Introduction

Laparoscopic bariatric surgery (LBS) in liver end-stage organ disease has been proven to improve organ function and patients’ symptoms. A series of LBS in patients with cirrhosis have shown good results in weight loss, but increased risk of complications. Current literature is based on clinical series. This paper aims to compare LBS (69% gastric bypass) between patients with cirrhosis and without cirrhosis.

Methods

We conducted a retrospective 1:3 matched case-control study including bariatric patients with cirrhosis and without cirrhosis. Demographics, operative variables, postoperative complications, long-term weight loss, and comorbidity resolution were compared between groups.

Results

Sixteen Child A patients were included in the patients with cirrhosis (PC) group and 48 in patients without cirrhosis (control) group. Mean age was 50 years; preoperative BMI was 39 ± 6.8 kg/m². Laparoscopic gastric bypass and laparoscopic sleeve gastrectomy were performed in 69% and 31%, respectively. Follow-up was 81% at 2 years for both groups. PC group had a higher rate of overall (31% vs. 6%; p < 0.05) and severe (Clavien-Dindo ≥ III; 13% vs. 0%; p = 0.013) complications than that of the control group. Mean %EWL of PC at 2 years of follow-up was 84.9%, without differences compared with that of the control group (83.1%). Comorbidity remission in PC was 14%, 50%, and 85% for hypertension, type 2 diabetes, and dyslipidemia, respectively. Patients without cirrhosis had a higher resolution rate of hypertension (65% vs. 14%, p = 0.03).

Conclusion

LBS is effective for weight loss and comorbidity resolution in patients with obesity and Child A liver cirrhosis. However, these results are accompanied by significantly increased risk of complications.

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Title: Bariatric Surgery in Cirrhotic Patients: a Matched Case-Control Study
Authors: Nicolás Quezada
Gregorio Maturana
María Jesús Irarrázaval
Rodrigo Muñoz
Sebastián Morales
Pablo Achurra
Cristóbal Azócar
Fernando Crovari
Publication date: 01-12-2020
Publisher: Springer US
Keywords: Dyslipidemia
Bariatric Surgery
Bariatric Surgery
Liver Cirrhosis
Hypertension
Arterial Hypertension
Arterial Hypertension
Published in: Obesity Surgery / Issue 12/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-020-04929-y

At a glance: The STEP trials

Springer Medicine

Bariatric Surgery in Cirrhotic Patients: a Matched Case-Control Study

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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