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Bariatric Surgery in Patients with Cirrhosis and Portal Hypertension

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Abstract

Introduction

Studies on bariatric patients with cirrhosis and portal hypertension are limited. The aim of this study was to review our experience in cirrhotic patients with portal hypertension who had bariatric surgery.

Method

All cirrhotic patients with portal hypertension who underwent laparoscopic bariatric surgery, from 2007 to 2017, were retrospectively reviewed.

Results

Thirteen patients were included; eight (62%) were female. The median age was 54 years (interquartile range, IQR 49–60) and median BMI was 48 kg/m2 (IQR 43–55). Portal hypertension was diagnosed based on endoscopy (n = 5), imaging studies (n = 3), intraoperative increased collateral circulation (n = 2), and endoscopy and imaging studies (n = 3). The bariatric procedures included sleeve gastrectomy (n = 10, 77%) and Roux-en-Y gastric bypass (n = 3, 23%). The median length of hospital stay was 3 days (IQR 2–4). Three 30-day complications occurred including wound infection (n = 1), intra-abdominal hematoma (n = 1), and subcutaneous hematoma (n = 1). No intraoperative or 30-day mortalities. There were 11 patients (85%) at 1-year follow-up and 9 patients (69%) at 2-year follow-up. At 2 years, the median percentage of excess weight loss (EWL) and total weight loss (TWL) were 49 and 25%, respectively. There was significant improvement in diabetes (100%), dyslipidemia (100%), and hypertension (50%) at 2 years after surgery.

Conclusion

Bariatric surgery in selected cirrhotic patients with portal hypertension is relatively safe and effective.

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References

  1. Hanipah ZN, Schauer PR. Surgical treatment of obesity and diabetes. Gastrointest Endosc Clin N Am. 2017;27(2):191–211.

    Article  PubMed  Google Scholar 

  2. Fabbrini E, Sullivan S, Klein S. Obesity and nonalcoholic fatty liver disease: biochemical, metabolic, and clinical implications. Hepatology. 2010;51:679–89.

    Article  CAS  PubMed  Google Scholar 

  3. Clark JM. The epidemiology of nonalcoholic fatty liver disease in adults. J Clin Gastroenterol. 2006;40:S5–10.

    PubMed  Google Scholar 

  4. Wong RJ, Aguilar M, Cheung R, et al. Nonalcoholic steatohepatitis is the second leading etiology of liver disease among adults awaiting liver transplantation in the United States. Gastroenterology. 2015;148:547–55.

    Article  PubMed  Google Scholar 

  5. Schauer PR, Bhatt DL, Kirwan JP, et al. STAMPEDE investigators. Metabolic surgery vs. intensive medical therapy for diabetes: 5-year outcomes. N Engl J Med. 2017;376:641–51.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Schauer PR, Mingrone G, Ikramuddin S, et al. Clinical outcomes of metabolic surgery: efficacy of glycemic control, weight loss, and remission of diabetes. Diabetes Care. 2016;39:902–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Targher G, Arcaro G. Non-alcoholic fatty liver disease and increased risk of cardiovascular disease. Atherosclerosis. 2007;191:235–40.

    Article  CAS  PubMed  Google Scholar 

  8. Targher G, Byrne CD, Lonardo A, et al. Nonalcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis of observational studies. J Hepatol. 2016;65:589–600.

    Article  PubMed  Google Scholar 

  9. Adams LA, Lymp JF, Sauver JS, et al. The natural history of nonalcoholic fatty liver disease: a population-based cohort study. Gastroenterology. 2005;129:113–21.

    Article  PubMed  Google Scholar 

  10. Rabl C, Campos GM. The impact of bariatric surgery on nonalcoholic steatohepatitis. Semin Liver Dis. 2012;32:80–91.

    Article  CAS  PubMed  Google Scholar 

  11. Neeff H, Mariaskin D, Spangenberg HC, et al. Perioperative mortality after non-hepatic general surgery in patients with liver cirrhosis: an analysis of 138 operations in the 2000s using child and MELD scores. J Gastrointest Surg. 2011;15:1–11.

    Article  PubMed  Google Scholar 

  12. Mosko JD, Nguyen GC. Increased perioperative mortality following bariatric surgery among patients with cirrhosis. Clin Gastroenterol Hepatol. 2011;9:897–901.

    Article  PubMed  Google Scholar 

  13. Wu R, Ortiz J, Dallal R. Is bariatric surgery safe in cirrhotics? Hepat Mon. 2013;13(2):e8536.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pestana L, Swain J, Dierkhising R, et al. Bariatric surgery in patients with cirrhosis with and without portal hypertension: a single-center experience. Mayo Clin Proc. 2015;90:209–15.

    Article  PubMed  Google Scholar 

  15. Groszmann R, Vorobioff JD, Gao H. Measurement of portal pressure: when, how, and why to do it. Clin Liver Dis. 2006;10:499–512. viii

    Article  PubMed  Google Scholar 

  16. Thalheimer U, Bellis L, Puoti C, et al. Should we routinely measure portal pressure in patients with cirrhosis, using hepatic venous pressure gradient (HVPG) as a guide for prophylaxis and therapy of bleeding and rebleeding? No. Eur J Intern Med. 2011;22:5–7.

    Article  PubMed  Google Scholar 

  17. Brethauer SA, Kim J, El Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11:489–506.

    Article  PubMed  Google Scholar 

  18. American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes Care. 2017;40(Supplement 1):S11–24.

    Article  Google Scholar 

  19. American Diabetes Association. 9. Cardiovascular disease and risk management. Diabetes Care. 2017;40(Supplement 1):S75–87.

    Article  Google Scholar 

  20. Dallal RM, Mattar SG, Lord JL, et al. Results of laparoscopic gastric bypass in patients with cirrhosis. Obes Surg. 2004;14:47–53.

    Article  PubMed  Google Scholar 

  21. Shimizu H, Phuong V, Maia M, et al. Bariatric surgery in patients with liver cirrhosis. Surg Obes Relat Dis. 2013;9:1–6.

    Article  PubMed  Google Scholar 

  22. Jan A, Narwaria M, Mahawar KK. A systematic review of bariatric surgery in patients with liver cirrhosis. Obes Surg. 2015;25:1518–26.

    Article  PubMed  Google Scholar 

  23. Kim JJ, Dasika NL, Yu E, et al. Cirrhotic patients with a transjugular intrahepatic portosystemic shunt undergoing major extrahepatic surgery. J Clin Gastroenterol. 2009;43:574–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, M61, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Zubaidah Nor Hanipah, Suriya Punchai, Stacy A. Brethauer, Ali Aminian & Philip R. Schauer

  2. Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia

    Zubaidah Nor Hanipah

  3. Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Suriya Punchai

  4. Gastroenterology and Hepatology, Pathobiology and Transplantation Center, Clelveland Clinic, Cleveland, OH, USA

    Arthur McCullough & Srinivasan Dasarathy

Authors
  1. Zubaidah Nor Hanipah
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  2. Suriya Punchai
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  3. Arthur McCullough
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  4. Srinivasan Dasarathy
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  5. Stacy A. Brethauer
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  6. Ali Aminian
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  7. Philip R. Schauer
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Corresponding author

Correspondence to Philip R. Schauer.

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Presentation

This study was presented at the SAGES 2017, Houston, Texas.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and /or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

This study does not require informed consent.

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Hanipah, Z.N., Punchai, S., McCullough, A. et al. Bariatric Surgery in Patients with Cirrhosis and Portal Hypertension. OBES SURG 28, 3431–3438 (2018). https://doi.org/10.1007/s11695-018-3372-z

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  • DOI: https://doi.org/10.1007/s11695-018-3372-z

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