Obesity Surgery

, Volume 30, Issue 1, pp 69–76 | Cite as

Intraoperative Liver Biopsy During Adolescent Bariatric Surgery: Is It Really Necessary?

  • R. Ellen Jones
  • Ann Ming Yeh
  • Neerajah Kambham
  • Marwa Abu El Haija
  • Janey Pratt
  • Matias BruzoniEmail author
Original Contributions



Nonalcoholic fatty liver disease (NAFLD) is prevalent in children with obesity and is definitively diagnosed with liver biopsy. However, the utility of routine biopsy during adolescent bariatric surgery remains unknown. We describe the usefulness of routine versus selective intraoperative liver biopsy in adolescents undergoing bariatric surgery.


A retrospective review of adolescents who received bariatric surgery at our institution between 2007 and 2018 was performed. Prior to 2014, all patients routinely received intraoperative liver biopsy. After 2014, biopsy was performed selectively on an individual basis for transaminitis or clinical concern. Demographic, biochemical, and histopathologic data were compared between patients who underwent routine, selective, or no biopsy.


There were 77 patients who received bariatric surgery during the study period: 32 underwent routine biopsy, 13 selective biopsy, and 32 no biopsy. Selective liver biopsy was more likely to show pathologic evidence of fibrosis (84.6% versus 31.2%, p = 0.000) and steatosis (100.0% versus 59.4%, p = 0.003), and higher mean NAFLD activity score compared with routine biopsies (4.4 versus 2.1, p = 0.001). Patients with steatosis had significantly higher preoperative fasting insulin (41.4 versus 21.1 mIU/L, p = 0.000), and patients with fibrosis had significantly higher glycated hemoglobin (6.1% versus 5.5%, p = 0.033) and alanine aminotransferase (81.5 versus 52.7 mg/dL, p = 0.043). There were no biopsy complications or changes in management due to biopsy results.


Routine intraoperative liver biopsy during adolescent bariatric surgery possesses questionable benefit, as it does not appear to impact short-term postoperative management. Prospective, longitudinal studies are needed to better understand the meaningfulness of liver histopathology in this population.


Liver biopsy Adolescent Bariatric surgery Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Utility 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human Rights Declaration

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery, Division of Pediatric SurgeryStanford University Medical CenterStanfordUSA
  2. 2.Department of Pediatrics, Division of GastroenterologyStanford University Medical CenterStanfordUSA
  3. 3.Department of Clinical PathologyStanford University Medical CenterStanfordUSA

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