Mayo Clinic Proceedings Home

Bariatric Surgery in Patients With Cirrhosis With and Without Portal Hypertension: A Single-Center Experience



      To assess safety and outcomes (metabolic and liver) of bariatric surgery in patients with cirrhosis with or without portal hypertension.

      Patients and Methods

      This study is a retrospective review of 14 patients with Child’s A cirrhosis with or without portal hypertension who were prospectively enrolled from February 23, 2009, through November 9, 2011, with 6- to 24-month follow-up after bariatric surgery (11 patients underwent sleeve gastrectomy [78.6%] and 3 gastric bypass [21.4%]). Four patients had portal hypertension detected by esophagogastroduodenoscopy.


      The mean patient age was 55.5 years, and 10 of 14 patients were women. The mean weight decreased from 125±18 to 94±17 at 1 year (P<.001) and 93±17 kg at 2 years (P<.001) postsurgery. The prevalence of diabetes decreased from 10 of 14 patients to 4 of 12 (P=.01) and 1 of 6 (P=.02) at 1 and 2 years postsurgery. The frequency of dyslipidemia and hypertension decreased but was not statistically significant; however, the number of medications required to control them decreased. Hepatic steatosis was detected by perioperative liver biopsy in 13 of 14 patients (5%-30% steatosis in 6 patients, 31%-60% in 6, and >60% in 1). At 1 year postsurgery, only 1 of 8 patients who underwent follow-up ultrasound imaging showed evidence of steatosis. The bilirubin level was above 2 mg/dL in 1 patient at 1 year postsurgery. One patient had encephalopathy at 2 years postsurgery. None of the patients developed peri- or postoperative bleeding or surgical complications.


      Bariatric surgery in patients with compensated cirrhosis even with mild portal hypertension is well tolerated and safe with minimal risk of postoperative complications if performed in a large referral center. This population can experience the beneficial effects of weight loss and improved metabolic syndrome, as well as reduced hepatic steatosis.

      Abbreviations and Acronyms:

      ALT (alanine aminotransferase), NASH (nonalcoholic steatohepatitis)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Adams T.D.
        • Gress R.E.
        • Smith S.C.
        • et al.
        Long-term mortality after gastric bypass surgery.
        N Engl J Med. 2007; 357: 753-761
        • Buchwald H.
        • Avidor Y.
        • Braunwald E.
        • et al.
        Bariatric surgery: a systematic review and meta-analysis.
        JAMA. 2004; 292 ([published correction appears in JAMA 2005;293(14):1728]): 1724-1737
        • Chang S.H.
        • Stoll C.R.
        • Song J.
        • Varela J.E.
        • Eagon C.J.
        • Colditz G.A.
        The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012.
        JAMA Surg. 2014; 149: 275-287
        • Teh S.H.
        • Nagorney D.M.
        • Stevens S.R.
        • et al.
        Risk factors for mortality after surgery in patients with cirrhosis.
        Gastroenterology. 2007; 132: 1261-1269
        • Mosko J.D.
        • Nguyen G.C.
        Increased perioperative mortality following bariatric surgery among patients with cirrhosis.
        Clin Gastroenterol Hepatol. 2011; 9: 897-901
        • Dallal R.M.
        • Mattar S.G.
        • Lord J.L.
        • et al.
        Results of laparoscopic gastric bypass in patients with cirrhosis.
        Obes Surg. 2004; 14: 47-53
        • Kral J.G.
        • Thung S.N.
        • Biron S.
        • et al.
        Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis.
        Surgery. 2004; 135: 48-58
        • Mathurin P.
        • Hollebecque A.
        • Arnalsteen L.
        • et al.
        Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease.
        Gastroenterology. 2009; 137: 532-540
        • Shimizu H.
        • Phuong V.
        • Maia M.
        • et al.
        Bariatric surgery in patients with liver cirrhosis.
        Surg Obes Relat Dis. 2013; 9: 1-6
        • Mummadi R.R.
        • Kasturi K.S.
        • Chennareddygari S.
        • Sood G.K.
        Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis.
        Clin Gastroenterol Hepatol. 2008; 6: 1396-1402

      Linked Article

      • Correction
        Mayo Clinic ProceedingsVol. 90Issue 4
        • Preview
          In the Original Article entitled, “Bariatric Surgery in Patients With Cirrhosis With and Without Portal Hypertension: A Single-Center Experience” published in the February 2015 issue of Mayo Clinic Proceedings (Mayo Clin Proc. 2015;90(2):209-215), the following sentence was incorrect: According to a National Inpatient Sample study,5 the mortality risk of bariatric surgery in patients without cirrhosis is 2 to 3 times that in patients with well-compensated cirrhosis and 32 times that in patients with decompensated cirrhosis.
        • Full-Text
        • PDF