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Sleeve Gastrectomy After Liver Transplantation: Feasibility and Outcomes

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Abstract

Background

Knowledge regarding the feasibility and safety of sleeve gastrectomy (SG) in obese liver transplant recipients is scarce. We report our experience of sleeve gastrectomy following liver transplantation (LT).

Methods

All patients who had undergone LT and subsequently underwent SG at our institution were retrospectively reviewed. Surgical outcomes, liver and kidney function tests, outcomes of obesity-related comorbidities, and excess weight loss were analyzed.

Results

Between May 2008 and February 2015, six consecutive patients underwent SG after LT. Three procedures (50%) were performed totally by laparoscopy, and three by upfront laparotomy for concomitant incisional hernia complex repair. Within the first 30 days, one complication occurred: early gastric fistula that required multiple endoscopic procedures and re-intervention, followed by death 19 months after SG due to multi-organ failure. Another patient had one late complication: chronic infection on a parietal mesh successfully controlled by mesh removal. Excess weight loss averaged 76% at 2 years with a median BMI of 28 (21–39) kg/m2. Median follow-up was 37.2 months (range 13–101 months). Median length of stay was 9 days (range: 6–81 days).

Conclusions

SG is technically feasible after LT and resulted in weight loss without adversely affecting graft function and immunosuppression. However, morbidity and mortality are high.

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Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 Avenue de Lattre de Tassigny, 94010, Creteil, France

    Michael Osseis, Chady Salloum, Concepcion Gomez Gavara, Philippe Compagnon, Chetana Lim & Daniel Azoulay

  2. Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Creteil, France

    Andrea Lazzati & Daniel Azoulay

  3. UNITE INSERM 955, Creteil, France

    Philippe Compagnon, Cyrille Feray & Daniel Azoulay

  4. Department of Hepatology, Henri Mondor Hospital, Creteil, France

    Cyrille Feray

Authors
  1. Michael Osseis
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  2. Andrea Lazzati
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  3. Chady Salloum
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  4. Concepcion Gomez Gavara
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  5. Philippe Compagnon
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  7. Chetana Lim
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  8. Daniel Azoulay
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Correspondence to Daniel Azoulay.

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The authors declare that they have no competing interests.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Michael Osseis and Andrea Lazzati are co-first authors

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Osseis, M., Lazzati, A., Salloum, C. et al. Sleeve Gastrectomy After Liver Transplantation: Feasibility and Outcomes. OBES SURG 28, 242–248 (2018). https://doi.org/10.1007/s11695-017-2843-y

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  • DOI: https://doi.org/10.1007/s11695-017-2843-y

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