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Bariatric Surgery in Cirrhotic Patients: a Matched Case-Control Study

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Abstract

Introduction

Laparoscopic bariatric surgery (LBS) in liver end-stage organ disease has been proven to improve organ function and patients’ symptoms. A series of LBS in patients with cirrhosis have shown good results in weight loss, but increased risk of complications. Current literature is based on clinical series. This paper aims to compare LBS (69% gastric bypass) between patients with cirrhosis and without cirrhosis.

Methods

We conducted a retrospective 1:3 matched case-control study including bariatric patients with cirrhosis and without cirrhosis. Demographics, operative variables, postoperative complications, long-term weight loss, and comorbidity resolution were compared between groups.

Results

Sixteen Child A patients were included in the patients with cirrhosis (PC) group and 48 in patients without cirrhosis (control) group. Mean age was 50 years; preoperative BMI was 39 ± 6.8 kg/m2. Laparoscopic gastric bypass and laparoscopic sleeve gastrectomy were performed in 69% and 31%, respectively. Follow-up was 81% at 2 years for both groups. PC group had a higher rate of overall (31% vs. 6%; p < 0.05) and severe (Clavien-Dindo ≥ III; 13% vs. 0%; p = 0.013) complications than that of the control group. Mean %EWL of PC at 2 years of follow-up was 84.9%, without differences compared with that of the control group (83.1%). Comorbidity remission in PC was 14%, 50%, and 85% for hypertension, type 2 diabetes, and dyslipidemia, respectively. Patients without cirrhosis had a higher resolution rate of hypertension (65% vs. 14%, p = 0.03).

Conclusion

LBS is effective for weight loss and comorbidity resolution in patients with obesity and Child A liver cirrhosis. However, these results are accompanied by significantly increased risk of complications.

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  1. Nicolás Quezada and Gregorio Maturana contributed equally to this work.

Authors and Affiliations

  1. Department of Digestive Surgery, Upper Gastrointestinal and Hernia surgery division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, 362 Diagonal Paraguay, 4th Floor - Office 410, Santiago, Región Metropolitana, Chile

    Nicolás Quezada, Rodrigo Muñoz, Pablo Achurra & Fernando Crovari

  2. Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Avda. Libertador Bernando O’Higgins 340, Santiago, Chile

    Gregorio Maturana, María Jesús Irarrázaval, Sebastián Morales & Cristóbal Azócar

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  1. Nicolás Quezada
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Quezada, N., Maturana, G., Irarrázaval, M.J. et al. Bariatric Surgery in Cirrhotic Patients: a Matched Case-Control Study. OBES SURG 30, 4724–4731 (2020). https://doi.org/10.1007/s11695-020-04929-y

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