Longitudinal Comparison of the Effect of Gastric Bypass to Sleeve Gastrectomy on Liver Function in a Bariatric Cohort: Tehran Obesity Treatment Study (TOTS)
Patients with morbid obesity commonly have fatty liver disease and elevated liver enzymes. While surgery effectively induces weight loss, bariatric techniques may differ regarding liver function improvement.
To evaluate and compare the trends of liver function recovery after gastric bypass surgery (GB) with sleeve gastrectomy (SG).
University hospitals, Iran.
Adult bariatric candidates without a history of alcohol consumption or other etiologies of liver disease who underwent SG (n = 682) or GB (n = 355) were included. Trends of weight loss parameters and alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP) at 0, 6 (in 90.4%), 12 (in 83.5%), and 24 months (in 67.1%) were compared using generalized estimating equations method.
Overall, 1037 patients with mean age of 38.4 ± 11.2 and mean body mass index of 44.9 ± 6.2 kg/m2 were analyzed. Seventy-eight percent of patients had fatty liver by ultrasound. Both GB and SG patients lost significant weight, with GB patients having a higher percentage of excess weight loss at 24 months (80.1% vs. 75.9%, Pbetween-group = .008). SG patients showed more favorable trends in liver chemistries with significantly lower ALT at 12 months and AST and ALP levels at 6 and 12 months. However, the two groups were comparable at 24 months. Significantly more GB patients developed high ALT at 6 and high AST at 6 and 12 months. Undergoing GB was associated with smaller 0–12-month changes in ALT, AST, and ALP.
Bariatric surgery resulted in improvement in liver function parameters, with SG showing advantages over GB in the first postoperative year.
KeywordsBariatric surgery Gastric bypass Nonalcoholic fatty liver disease Liver function tests Morbid obesity
The authors would like to thank Dr. Mohammad Hassan Kalantar Motamedi for his editorial assistance and language editing of the manuscript.
Compliance with Ethical Standards
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. This study was reviewed and approved by the institutional Human Research Review Committee (No. 2ECRIES 93/03/13) and written informed consent was obtained from all patients prior to enrollment.
Conflict of Interest
The authors declare that they have no conflict of interest.
- 13.Barzin M, Motamedi MAK, Serahati S, et al. Comparison of the effect of gastric bypass and sleeve gastrectomy on metabolic syndrome and its components in a cohort: Tehran Obesity Treatment Study (TOTS). Obes Surg. 2017;27(7):1697–704. https://doi.org/10.1007/s11695-016-2526-0.CrossRefPubMedGoogle Scholar
- 17.Peterli R, Wolnerhanssen BK, Vetter D, et al. Laparoscopic sleeve gastrectomy versus Roux-Y-gastric bypass for morbid obesity-3-year outcomes of the prospective randomized Swiss Multicenter Bypass Or Sleeve Study (SM-BOSS). Ann Surg. 2017;265(3):466–73. https://doi.org/10.1097/sla.0000000000001929.CrossRefPubMedGoogle Scholar
- 23.Caiazzo R, Lassailly G, Leteurtre E, et al. Roux-en-Y gastric bypass versus adjustable gastric banding to reduce nonalcoholic fatty liver disease: a 5-year controlled longitudinal study. Ann Surg. 2014;260(5):893–8; discussion 98–9. https://doi.org/10.1097/sla.0000000000000945.CrossRefPubMedGoogle Scholar
- 25.Billeter AT, Senft J, Gotthardt D, et al. Combined non-alcoholic fatty liver disease and type 2 diabetes mellitus: sleeve gastrectomy or gastric bypass?-a controlled matched pair study of 34 patients. Obes Surg. 2016;26(8):1867–74. https://doi.org/10.1007/s11695-015-2006-y.CrossRefPubMedGoogle Scholar
- 30.Kalinowski P, Paluszkiewicz R, Ziarkiewicz-Wroblewska B, et al. Liver function in patients with nonalcoholic fatty liver disease randomized to Roux-en-Y gastric bypass versus sleeve gastrectomy: a secondary analysis of a randomized clinical trial. Ann Surg. 2017;266(5):738–45. https://doi.org/10.1097/SLA.0000000000002397.CrossRefPubMedGoogle Scholar