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Impact of laparoscopic sleeve gastrectomy on fibrosis stage in patients with child-A NASH-related cirrhosis

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Abstract

Purpose

Bariatric surgery can improve non-alcoholic fatty liver disease (NAFLD). Yet data on the effect on fibrosis are insufficient and controversial. This work endeavored to evaluate the safety of laparoscopic sleeve gastrectomy (LSG) in cases that have compensated non-alcoholic steatohepatitis (NASH)-related cirrhosis and its impact on fibrosis stage.

Methods

The current prospective work involved 132 cases with Child-A NASH-related cirrhosis suffering from morbid obesity scheduled for LSG. They were subjected to preoperative assessment, wedge biopsy, and ultrasound-guided true-cut liver biopsy after 30 months. Patients were included if proved to have F4 fibrosis initially. The liver condition was assessed based on the NALFD Activity Score (NAS). The primary outcome measure was the impact of LSG on fibrosis stage and its relation to weight loss.

Results

The analysis included only 71 patients who completed the 30-month follow-up period. By the end of the follow-up interval, there was a substantial weight loss with a reasonable resolution of comorbidities. The median NAS decreased significantly from 6 (1–8) to 3 (0–6) after surgery. Fibrosis score regressed to F2 in 19 patients (26.8%) and F3 in 29 (40.8%). Patients with improved scores had a significantly higher amount of weight loss (p < 0.001). Improvement was more frequent in males (p = 0.007). By 30 months after treatment, 53.8% of cases with borderline NASH and 36.8% of those with probable NASH showed complete resolution, and 44.7% of patients with NASH showed improvement. Steatosis improved in 74.6% of patients (p < 0.001).

Conclusion

In patients with NASH-related liver cirrhosis of Child class A, LSG may be a secure approach for the management of morbid obesity. It has a long-term benefit for both obesity and liver condition with significant improvement of steatosis, steatohepatitis, and fibrosis.

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Funding

This study was supported by the authors. No any other fund was received.

Author information

Authors and Affiliations

  1. General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    Mohamed Abdalla Salman & Hani Maurice Sabri Mikhail

  2. General Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

    Mohammed A. Nafea & Ahmed Abd El Aal Sultan

  3. General Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt

    Hossam E. Elshafey

  4. Alawi Tunsi Hospital, Mecca, Saudi Arabia

    Mohamed Tourky

  5. Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, 11311, Egypt

    Abeer Awad, Tarek Elsayed Abouelregal, Reham Abdelghany Ahmed, Omar Ashoush & Ahmed Abdallah Salman

  6. Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Alhoussein Alsayed AbdelAal

  7. National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt

    Hossam El-Din Shaaban & Mohamed Atallah

  8. Tropical Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    Mohamed Yousef

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  1. Mohamed Abdalla Salman
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Correspondence to Ahmed Abdallah Salman.

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Mohamed Abdalla Salman, Hani Maurice Sabri Mikhail, Mohammed A. Nafea, Ahmed Abd El Aal Sultan, Hossam E. Elshafey, Mohamed Tourky, Abeer Awad, Tarek Elsayed Abouelregal, Reham Abdelghany Ahmed, Omar Ashoush, Alhoussein Alsayed AbdelAal, Hossam El-Din Shaaban, Mohamed Atallah, Mohamed Yousef, Ahmed Abdallah Salman have no conflict of interest to declare.

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Salman, M.A., Mikhail, H.M.S., Nafea, M.A. et al. Impact of laparoscopic sleeve gastrectomy on fibrosis stage in patients with child-A NASH-related cirrhosis. Surg Endosc 35, 1269–1277 (2021). https://doi.org/10.1007/s00464-020-07498-4

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