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

      Abstract

      Objective

      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.

      Results

      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.

      Conclusion

      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)
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      Linked Article

      • Correction
        Mayo Clinic ProceedingsVol. 90Issue 4
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          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.
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