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Laparoscopic Adjustable Gastric Banding In Patients with Unexpected Cirrhosis: Safety and Outcomes

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An Erratum to this article was published on 18 April 2015

Abstract

Background

The safety and efficacy of laparoscopic adjustable gastric banding (LAGB) in the context of cirrhosis have not been established. We hypothesized that LAGB in cirrhotic patients is a safe procedure that may offer positive long-term benefits, both in terms of obesity and avoiding progression of liver disease.

Methods

Data were gathered from a prospectively maintained database of 8402 patients who had undergone LAGB from November 1993 and April 2014.

Results

Fourteen patients with biopsy-proven cirrhosis were identified in the database. In all cases, cirrhosis was an unexpected macroscopic finding at the time of surgery, confirmed with intraoperative biopsy. All patients were either Child-Pugh A or B. No patients had preoperative clinical evidence of decompensated liver disease. The mean initial weight was 116.6 kg and BMI 38.9. There was no operative mortality. Two patients experienced a surgical complication (Clavien-Dindo grade II and grade IIIa). At 12 months, the mean excess weight loss was 61.3 % giving a mean BMI 31.7. Repeat biopsies were available in three patients. All demonstrated improvement in inflammation and two had fibrosis regression. Baseline liver biochemistry was compared in nine patients who had repeat biochemistry studies after 12 months. There was a significant improvement in alanine transaminase (ALT) (p = 0.04) and aspartate transaminase (AST) (p = 0.02). Two patients developed hepatocellular carcinoma (HCC). One has died as a result of this disease 11 years after LAGB surgery.

Conclusion

LAGB may be a safe and effective bariatric intervention in patients with compensated cirrhosis. Our findings support the need for a prospective study with paired liver biopsies.

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Conflicts of Interest

The Centre for Obesity Research and Education (CORE) at Monash University receives a grant from Allergan for research support. The grant is not tied to any specified research projects, and Allergan has no control of the protocol, analysis and reporting of any studies.

CORE also receives a grant from Applied Medical towards educational programs. Authors Richard Woodford and Cheryl Laurie have no declarations. Author Wendy Brown received an honorarium from Allergan to attend a Surgical Advisory Panel in London in 2009. Author Paul Burton received an honorarium from Covidien for teaching in 2013. Author Paul O’Brien has written a patient information book entitled “The Lap-Band Solution: A Partnership for Weight Loss” which is given to patients without charge but some are sold to surgeons and others for which he received a royalty.

Individual informed consent was not sought. The patients were aware that their data were stored on an electronic database, and the Ethics committee approved the study without requirement for individual consent.

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Authors and Affiliations

  1. Centre for Obesity Research and Education, Monash University School of Public Health and Preventative Medicine, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia

    Richard M. Woodford, Paul R. Burton, Paul E. O’Brien, Cheryl Laurie & Wendy A. Brown

  2. Monash University Department of Surgery, The Alfred Hospital, 99 Commercial Road, Melbourne, VIC, 3004, Australia

    Wendy A. Brown

  3. Monash Health, 246 Clayton Rd, Clayton, VIC, 3168, Australia

    Richard M. Woodford

Authors
  1. Richard M. Woodford
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  2. Paul R. Burton
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  3. Paul E. O’Brien
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  4. Cheryl Laurie
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  5. Wendy A. Brown
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Corresponding author

Correspondence to Wendy A. Brown.

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Woodford, R.M., Burton, P.R., O’Brien, P.E. et al. Laparoscopic Adjustable Gastric Banding In Patients with Unexpected Cirrhosis: Safety and Outcomes. OBES SURG 25, 1858–1862 (2015). https://doi.org/10.1007/s11695-015-1623-9

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  • DOI: https://doi.org/10.1007/s11695-015-1623-9

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