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Bariatric Surgery is Effective and Safe for Obese Patients with Compensated Cirrhosis: A Systematic Review and Meta-Analysis

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Abstract

Background

With the global pandemic of obesity and nonalcoholic fatty liver disease (NAFLD), the incidence of cirrhosis associated with nonalcoholic steatohepatitis (NASH) has greatly increased. This study aimed to evaluate the efficacy and safety of bariatric surgery in obese cirrhotic patients.

Methods

PubMed, EMBASE, and the Cochrane Library were searched for relevant studies. Effectiveness outcomes were weight loss, remission of comorbidities, and improvement in liver function. Safety outcomes were procedural complications and mortality.

Results

A total of 15 studies were included in this meta-analysis. Patients with compensated cirrhosis lost weight significantly after surgery, and the percentage of excess weight loss was 60.44 (95% CI, 44.34 to 76.55). Bariatric surgery resulted in remission of NAFLD in 57.9% (95% CI, 27.5% to 88.3%), T2DM in 58.4% (95% CI, 48.4% to 68.4%), hypertension in 53.1% (95% CI, 43% to 63.3%), dyslipidemia in 59.8% (95% CI, 41.1% to 78.5%) of patients with cirrhosis. Bariatric surgery reduced the levels of alanine aminotransferase and aspartate aminotransferase. The incidence of surgical complications in patients with cirrhosis was about 19.2% (95% CI, 11.7% to 26.6%), which was higher than that in patients without cirrhosis (OR 2.67 [95% CI, 1.26 to 5.67]). Patients with cirrhosis had an overall mortality rate of 1.3%, and the mortality rates for compensated cirrhosis and decompensated cirrhosis were 0.9% and 18.2%, respectively.

Conclusions

Bariatric surgery is effective for weight loss, remission of comorbidities, and reversal of liver damage. Although cirrhotic patients have a higher risk of complications and death, bariatric surgery is relatively safe for well-compensated cirrhosis.

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Availability of data and materials

The datasets supporting the conclusions of this article are included within the article and its additional files.

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Funding

This study was supported by Beijing Municipal Science and Technology Project (No.Z171100002217070), National Key R&D Program of China (No.2017YFA0103000), National Science and Technology Key Project on “Major Infectious Diseases such as HIV/AIDS, Viral Hepatitis Prevention and Treatment” (NO. 2012ZX10002004-006, No.2017ZX10203201-005, 2017ZX10201201, No.2017ZX10202203-006–001 and No.2017ZX10302201-004–002), “Beijing Municipal Administration of Hospitals” Ascent Plan (No. DFL20151601), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support (No.ZYLX201806 and No. ZYLX202125), the Digestive Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals (No.XXZ0503), the You An fund for liver diseases and AIDS (YNKTTS201801189), the Basic-Clinical Cooperation Project of Capital Medical University (17JL47).

Author information

Authors and Affiliations

  1. Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Jie Bai & Yongguo Li

  2. General Surgery Department, Beijing Youan Hospital, Capital Medical University, Beijing, China

    Zhe Jia

  3. Fourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing Youan Hospital Affiliated to Capital Medical University, Beijing, China

    Yu Chen & Zhongping Duan

  4. Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China

    Yu Chen & Zhongping Duan

  5. First Department of Liver Disease, Beijing Youan Hospital Affiliated to Capital Medical University, Beijing, China

    Sujun Zheng

Authors
  1. Jie Bai
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  2. Zhe Jia
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  4. Yongguo Li
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Contributions

JB and ZJ contributed to conception and design. JB and ZJ contributed to systematic literature search and data extraction. JB contributed to data analysis. JB and ZJ contributed to manuscript draft. YC, YL, SZ, and ZD contributed to editing and revision. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yongguo Li, Sujun Zheng or Zhongping Duan.

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Bai, J., Jia, Z., Chen, Y. et al. Bariatric Surgery is Effective and Safe for Obese Patients with Compensated Cirrhosis: A Systematic Review and Meta-Analysis. World J Surg 46, 1122–1133 (2022). https://doi.org/10.1007/s00268-021-06382-z

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