Surgical Endoscopy

, Volume 27, Issue 1, pp 81–85

Safety and feasibility of sleeve gastrectomy in morbidly obese patients following liver transplantation

  • Matthew Y. C. Lin
  • M. Mehdi Tavakol
  • Ankit Sarin
  • Shadee M. Amirkiai
  • Stanley J. Rogers
  • Jonathan T. Carter
  • Andrew M. Posselt



Obesity, steroid-induced diabetes, hypercholesterolemia, and steatohepatitis can occur after liver transplantation and may respond to bariatric surgery. The safety and feasibility of bariatric surgery after liver transplantation is unknown.


Nine morbidly obese patients with prior liver transplants underwent sleeve gastrectomy in a pilot program. Sleeve gastrectomy was chosen over gastric banding to avoid foreign body implantation, and over gastric bypass to maintain endoscopic access to the biliary system and reduce surgical complexity. We reviewed patient demographics, operative details, 30-day complications, weight loss, postoperative hepatic and renal functions, and resolution of comorbidities.


Sleeve gastrectomy was performed laparoscopically in eight patients and as an open procedure in one patient. The mean operative time was 165 min and mean postoperative length of stay was 5 days. Follow-up ranged from 3 to 36 months. In the first 30 days, there were three complications in three patients: mesh dehiscence after a synchronous incisional hernia repair, bile leak from the liver surface requiring laparoscopic drainage, and postoperative dysphagia that required reoperation. Calcineurin inhibitor levels and hepatic and renal functions remained stable. There were no episodes of graft rejection. At 3 months liver function tests remained stable. Excess weight loss averaged 55.5 % at 6 months.


Sleeve gastrectomy is technically feasible after liver transplantation and resulted in weight loss without adversely affecting graft function and immunosuppression. Early complications may be more frequent as a result of adhesions of the left upper quadrant. Late complications were rare.


Laparoscopy Transplant Sleeve gastrectomy 


  1. 1.
    Youfa W, Beydoun M (2007) The obesity epidemic in the United States––gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiol Rev 29(1):6–28CrossRefGoogle Scholar
  2. 2.
    2010 Annual Report of the US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Transplant Data 19942009. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation, Rockville, MD; United Network for Organ Sharing, Richmond, VA; University Renal Research and Education Association, Ann Arbor, MIGoogle Scholar
  3. 3.
    Laish I, Braun M, Mor E, Sulkes J, Harif Y, Ben AZ (2011) Metabolic syndrome in liver transplant recipients: prevalence, risk factors, and association with cardiovascular events. Liver Transpl 17:15–22CrossRefPubMedGoogle Scholar
  4. 4.
    Leonard J, Heimbach JK, Mlinchoc M, Watt K, Charlton M (2008) The impact of obesity on long-term outcomes in liver transplant recipients––results of the NIDDK liver transplant database. Am J Transplant 8(3):667–672CrossRefPubMedGoogle Scholar
  5. 5.
    Schaeffer DF, Yoshida EM, Buczkowski AK, Chung SW, Steinbrech UP, Erb SE, Scudamore CH (2009) Surgical morbidity in severely obese liver transplant recipients––a single Canadian centre experience. Ann Hepatol 8(1):38–40PubMedGoogle Scholar
  6. 6.
    Zaydfudim V, Feurer I, Moore D, Wisawatapnimit P, Wright JK, Pinson CW (2009) The negative effect of pretransplant overweight and obesity on the rate of improvement in physical quality of life after liver transplantation. Surgery 146(2):174–180CrossRefPubMedGoogle Scholar
  7. 7.
    Butte JM, Devaud N, Jarufe N, Boza C, Perez G, Torres J, Perez-Ayuso RM, Arrese M, Martinez J (2007) Sleeve gastrectomy as treatment for severe obesity after orthotopic liver transplantation. Obes Surg 17(11):1517–1519CrossRefPubMedGoogle Scholar
  8. 8.
    Charlton M (2009) Obesity, hyperlipidemia, and metabolic syndrome. Liver Transpl 15(Suppl 2):S83–S89CrossRefPubMedGoogle Scholar
  9. 9.
    Choban P, Flancbaum L (1997) The impact of obesity on surgical outcomes: a review. J Am Coll Surg 185:593–603CrossRefPubMedGoogle Scholar
  10. 10.
    Himpens J, Dapri G, Cadiere GB (2006) A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 16:1430–1436Google Scholar
  11. 11.
    Takata MC, Campos GM, Ciovica R, Rabl C, Rogers SJ, Cello JP, Ascher NL, Posselt AM (2008) Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation. Surg Obes Relat Dis 4(2):159–164; discussion 164–165CrossRefPubMedGoogle Scholar
  12. 12.
    Chopra A, Chao E, Etkin Y, Merklinger L, Lieb J, Delany H (2012) Laparoscopic sleeve gastrectomy for obesity: can it be considered a definitive procedure? Surg Endosc 26(3):831–837CrossRefPubMedGoogle Scholar
  13. 13.
    Tichansky D, Madan A (2005) Laparoscopic Roux-en-Y gastric bypass is safe and feasible after orthotopic liver transplantation. Obes Surg 15:1481–1486CrossRefPubMedGoogle Scholar
  14. 14.
    Sherman S, Shaked A, Cryer HM, Goldstein LI, Busuttil RW (1993) Endoscopic management of biliary fistulas complicating liver transplantation and other hepatobiliary operations. Ann Surg 218(2):167–175CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Matthew Y. C. Lin
    • 1
  • M. Mehdi Tavakol
    • 1
  • Ankit Sarin
    • 1
  • Shadee M. Amirkiai
    • 1
  • Stanley J. Rogers
    • 1
  • Jonathan T. Carter
    • 1
  • Andrew M. Posselt
    • 1
  1. 1.Department of SurgeryUniversity of California, San Francisco, School of MedicineSan FranciscoUSA

Personalised recommendations