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Safety and Efficacy of Bariatric Surgery in Advanced Liver Fibrosis

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Abstract

Background

There is limited data on the safety and efficacy of metabolic and bariatric (MBS) surgery in patients with advanced liver fibrosis.

Methods

This is a retrospective analysis of data of patients with advanced liver fibrosis undergoing MBS at a tertiary care centre. Weight loss and complications were analysed. Transient elastography and liver biopsy findings 1 year after surgery were compared with baseline.

Results

Twenty-two patients had cirrhosis and 16 had stage 3 fibrosis; all were Child Pugh A. Majority (76%) underwent sleeve gastrectomy. Mean excess BMI loss was 65.8 ± 18.9%. There were no leaks or 30-day mortality. One patient with cirrhosis had late mortality due to liver decompensation. Preoperative and postoperative median LSM were 15.5 kPa (interquartile range IQR = 24.4–11.6) and 10.9 kPa (IQR 19.3–7.6), respectively. Preoperative and postoperative median CAP were 352.5 dB/m (IQR = 372–315.5) and 303 dB/m (IQR 331–269.5), respectively. On follow-up biopsy, nine of twelve patients had improvement in fibrosis, while three had no change. Four out of five patients in the cirrhotic cohort had improvement in fibrosis stage and LSM improved in all of them. Five out of seven patients with stage 3 fibrosis had an improvement in fibrosis stage and none progressed to cirrhosis. LSM improved in three of these five patients.

Conclusion

MBS has the potential to ameliorate advanced liver fibrosis, including cirrhosis. Transient elastography can be used as an effective tool for screening and follow-up of liver disease in patients undergoing MBS.

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Authors and Affiliations

  1. Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India

    Aashir Kaul, Vitish Singla, Aditya Baksi, Sandeep Aggarwal & Amit Bhambri

  2. Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India

    Dr Shalimar

  3. Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

    Rajni Yadav

Authors
  1. Aashir Kaul
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  2. Vitish Singla
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  3. Aditya Baksi
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  4. Sandeep Aggarwal
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  5. Amit Bhambri
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  6. Dr Shalimar
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  7. Rajni Yadav
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Corresponding author

Correspondence to Sandeep Aggarwal.

Ethics declarations

The study was undertaken after clearance from Institutional Ethics Committee. There was no commission or omission of intervention for the study purpose and all the interventions were done in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

A written informed consent was taken from each patient for the surgical procedure.

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The authors declare that they have no conflict of interest.

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Kaul, A., Singla, V., Baksi, A. et al. Safety and Efficacy of Bariatric Surgery in Advanced Liver Fibrosis. OBES SURG 30, 4359–4365 (2020). https://doi.org/10.1007/s11695-020-04827-3

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  • DOI: https://doi.org/10.1007/s11695-020-04827-3

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