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Outcomes of Bariatric Surgery in Patients with Cirrhosis

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Abstract

Context

Information concerning the risk–benefit profile of bariatric surgery in subjects with liver cirrhosis is scarce. Our aim was to describe the long-term outcomes of bariatric surgery in a cohort of patients with liver cirrhosis submitted to bariatric surgery.

Methods

This was a multicenter, retrospective observational study performed by the Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN), with a review of patients with cirrhosis who had undergone bariatric surgery during the period from April 2004 to March 2017 in ten public reference hospitals in Spain.

Results

Data on 41 patients with cirrhosis submitted to obesity surgery were collected (mean age 53.8 ± 7.9 years, 46.3% women, presurgical BMI 45 ± 8.3 kg/m2). All but one patient belonged to Child–Pugh class A, and sleeve gastrectomy was conducted in 68.3% of cases. Percentage of total weight loss (%TWL) was 26.33 ± 8.3% and 21.16 ± 15.32% at 1 and 5 years after surgery, respectively. This was accompanied by a significant reduction of type 2 diabetes, high blood pressure, and dyslipidemia and by an improvement of liver enzymes over time. Model for End-Stage Liver Disease (MELD) index increased from 7.2 ± 1.9 to 9.8 ± 4.6 after 5 years. Seven patients (17%) developed early postsurgical complications. No postsurgical mortality was observed. During follow-up, only five patients developed liver decompensation.

Conclusions

Bariatric surgery in selected patients with liver cirrhosis has metabolic benefits that could have a positive impact on liver prognosis.

Trial Registration

Controlledtrials.com Identifier: 10.1186/ISRCTN15009106

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Acknowledgments

We would like to thank The Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN) for participating and providing data for this study. The authors thank Martin Price for his valuable help with the English version of the manuscript.

Author information

Author notes

  1. Inka Miñambres and Miguel Angel Rubio contributed equally to this work.

Authors and Affiliations

  1. Endocrinology and Nutrition Department, Hospital de La Santa Creu i Sant Pau, C/Sant Antoni Maria Claret 167, 08025, Barcelona, Spain

    Inka Miñambres

  2. Medicine Department, Universitat Autònoma de Barcelona, C/Sant Antoni Maria Claret 167, 08025, Barcelona, Spain

    Inka Miñambres, Albert Goday & German Soriano

  3. Endocrinology and Nutrition Department. Hospital Clínico San Carlos. IDISSC. Facultad de Medicina, Universidad Complutense, C/ Martín Lagos s/n, 28040, Madrid, Spain

    Miguel Angel Rubio & Clara Marcuello

  4. Obesity Unit, Hospital Clínic Universitari, Barcelona Spain. C/Villarroel 170, 08036, Barcelona, Spain

    Ana de Hollanda

  5. Endocrinology and Nutrition Department, Hospital General Universitario Gregorio Marañón, IISGM. C/ Pez Austral 12, 4 °C, 28007, Madrid, Spain

    Irene Breton

  6. Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, C/ Feixa Llarga s/n, L’Hospitalet de Llobregat, 08907, Barcelona, Spain

    Nuria Vilarrasa

  7. CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain

    Nuria Vilarrasa, Silvia Pellitero & Albert Lecube

  8. Department of Endocrinology and Nutrition, Germans Trias i Pujol University Hospital-IGTP, ctra Canyet s/n Badalona, 08916, Barcelona, Spain

    Silvia Pellitero

  9. Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova. Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, University of Lleida, Av. Rovira Roure 80, 25198, Lleida, Catalonia, Spain

    Marta Bueno & Albert Lecube

  10. Endocrinology and Nutrition Department, Hospital del Mar, Paseo Maritimo 25-29, 08003, Barcelona, Spain

    Albert Goday

  11. Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, CIBERobn, Madrid, Spain

    Albert Goday

  12. Endocrinology and Nutrition Department, Complejo Asistencial Universitario de León, Edificio Administrativo Ala Sur, 1ª planta Altos de Nava s /n, 24008, Leon, Spain

    Maria D. Ballesteros

  13. Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, C/Sant Antoni Maria Claret 167, 08025, Barcelona, Spain

    German Soriano

  14. CIBERehd, Instituto de Salud Carlos III, Madrid, Spain

    German Soriano

  15. Department of Endocrinology and Nutrition, Parc Taulí University Hospital, UAB, Sabadell, Spain

    Assumpta Caixàs

Authors
  1. Inka Miñambres
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  2. Miguel Angel Rubio
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  3. Ana de Hollanda
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  4. Irene Breton
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  5. Nuria Vilarrasa
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  6. Silvia Pellitero
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  7. Marta Bueno
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  8. Albert Lecube
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  9. Clara Marcuello
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  10. Albert Goday
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  11. Maria D. Ballesteros
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  12. German Soriano
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  13. Assumpta Caixàs
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Corresponding authors

Correspondence to Inka Miñambres or Ana de Hollanda.

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The authors declare that they have no conflict of interest.

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Miñambres, I., Rubio, M.A., de Hollanda, A. et al. Outcomes of Bariatric Surgery in Patients with Cirrhosis. OBES SURG 29, 585–592 (2019). https://doi.org/10.1007/s11695-018-3562-8

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  • DOI: https://doi.org/10.1007/s11695-018-3562-8

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