Obesity Surgery

, Volume 25, Issue 8, pp 1518–1526 | Cite as

A Systematic Review of Bariatric Surgery in Patients with Liver Cirrhosis

  • Ahmad Jan
  • Mahendra Narwaria
  • Kamal K. MahawarEmail author
Review Article


Nonalcoholic steatohepatitis is becoming a common cause of liver cirrhosis and a significant number of patients undergoing bariatric surgery suffer with it. There is currently lack of consensus among surgeons regarding safety of bariatric surgery in patients with liver cirrhosis and the best bariatric procedure in these patients. This review investigates published English language scientific literature systematically in an attempt to answer these questions. Eleven studies that reported experience of bariatric surgery in cirrhotic obese patients were included in this review. This review shows an acceptably higher overall risk of complications and perioperative mortality with bariatric surgery in cirrhotic patients. Surgeons must discuss the possibility of an unexpected intraoperative diagnosis of cirrhosis preoperatively with all bariatric surgery patients and agree on a course of action.


Bariatric surgery Obesity surgery Non-alcoholic steatohepatitis Cirrhosis Roux-en-Y gastric bypass Sleeve gastrectomy Gastric banding Biliopancreatic diversion 



Non-alcoholic fatty liver disease


Non-alcoholic steatohepatitis


Preferred reporting items for systematic reviews and meta-analyses


Roux-en-Y gastric bypass


Sleeve gastrectomy


Biliopancreatic diversion


Adjustable gastric banding


Duodenal switch


Transjugular intrahepatic portosystemic shunt


Conflict of Interest

The authors declare that they have no competing interests.

Author Contribution

KM conceived the idea for the topic and wrote the manuscript. KM and AG independently collected information and analysed it. All authors participated in discussions on the topic. All authors have seen the final version and approve of it.


  1. 1.
    Angulo P. NAFLD, obesity and bariatric surgery. Gastroenterology. 2006;130(6):1848–52.PubMedCrossRefGoogle Scholar
  2. 2.
    Weingarten TN, Swain JM, Kendrick ML, et al. Nonalcoholic steatohepatitis (NASH) does not increase complications after laparoscopic bariatric surgery. Obes Surg. 2011;21(11):1714–20.PubMedCrossRefGoogle Scholar
  3. 3.
    Silverman JF, O’Brien KF, Long S, et al. Liver pathology in morbidly obese patients with and without diabetes. Am J Gastroenterol. 1990;85(10):1349–55.PubMedGoogle Scholar
  4. 4.
    Berzigotti A, Garcia-Tsao G, Bosch J, et al. Portal hypertension collaborative group. Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis. Hepatology. 2011;54(2):555–61.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Kral JG, Thung SN, Biron S, et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery. 2004;135(1):48–58.PubMedCrossRefGoogle Scholar
  6. 6.
    Takata MC, Campos GM, Ciovica R, et al. Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation. Surg Obes Relat Dis. 2008;4(2):159–64. discussion 164–5.Google Scholar
  7. 7.
    Millwala F, Nguyen GC, Thuluvath PJ. Outcomes of patients with cirrhosis undergoing non-hepatic surgery: Risk assessment and management. World J Gastroenterol. 2007;13(30):4056–63.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Csikesz NG, Nguyen LN, Tseng JF, et al. Nationwide volume and mortality after elective surgery in cirrhotic patients. J Am Coll Surg. 2009;208(1):96–103.PubMedCrossRefGoogle Scholar
  9. 9.
    Mosko JD, Nguyen GC. Increased perioperative mortality following bariatric surgery among patients with cirrhosis. Clin Gastroenterol Hepatol. 2011;9(10):897–901.PubMedCrossRefGoogle Scholar
  10. 10.
    Bromberger B, Porrett P, Choudhury R, et al. Weight loss interventions for morbidly obese patients with compensated cirrhosis: a Markov decision analysis model. J Gastrointest Surg. 2014;18(2):321–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Brolin RE, Bradley LJ, Taliwal RV. Unsuspected cirrhosis discovered during elective obesity operations. Arch Surg. 1998;133(1):84–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Shimizu H, Phuong V, Maia M, et al. Bariatric surgery in patients with liver cirrhosis. Surg Obes Relat Dis. 2013;9(1):1–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Rebibo L, Gerin O, Verhaeghe P, et al. Laparoscopic sleeve gastrectomy in patients with NASH-related cirrhosis: a case-matched study. Surg Obes Relat Dis. 2014;10(3):405–10.PubMedCrossRefGoogle Scholar
  14. 14.
    Dallal RM, Mattar SG, Lord JL, et al. Results of laparoscopic gastric bypass in patients with cirrhosis. Obes Surg. 2004;14(1):47–53.PubMedCrossRefGoogle Scholar
  15. 15.
    Sarr MG. Is a bariatric procedure appropriate in patients with portal hypertension secondary to cirrhosis? Surg Obes Relat Dis. 2006;2(3):405–6. discussion 406–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Woodford RM, Burton PR, O’Brien PE, et al. Laparoscopic adjustable gastric banding in patients with unexpected cirrhosis: Safety and outcomes. Obes Surg 2015. Feb 25 [Epub ahead of print].Google Scholar
  17. 17.
    Pestana L, Swain J, Dierkhising R, et al. Bariatric surgery in patients with cirrhosis with and without portal hypertension: a single-center experience. Mayo Clin Proc. 2015;90(2):209–15.PubMedCrossRefGoogle Scholar
  18. 18.
    Diniz Mde F, Moura LD, Kelles SM, et al. Long-term mortality of patients submitted to Roux-en-Y gastric bypass in Public Health System: high prevalence of alcoholic cirrhosis and suicides. Arq Bras Cir Dig. 2013;26 Suppl 1:53–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Baltasar A. Liver cirrhosis and bariatric operations. Surg Obes Relat Dis. 2006;2(5):580.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Ahmad Jan
    • 1
  • Mahendra Narwaria
    • 1
  • Kamal K. Mahawar
    • 2
    Email author
  1. 1.Asian Bariatric HospitalAhemdabadIndia
  2. 2.Bariatric UnitSunderland Royal HospitalSunderlandUK

Personalised recommendations