Open AccessConsiderations for bariatric surgery in patients with cirrhosis
Author(s) -
George Boon-Bee Goh,
Philip R. Schauer,
Arthur J. McCullough
Publication year - 2018
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v24.i28.3112
Subject(s) - medicine , steatohepatitis , cirrhosis , fatty liver , weight loss , obesity , context (archaeology) , metabolic syndrome , surgery , diabetes mellitus , intensive care medicine , sleeve gastrectomy , disease , type 2 diabetes , weight loss surgery , type 2 diabetes mellitus , gastric bypass , paleontology , biology , endocrinology
With the ever increasing global obesity pandemic, clinical burden from obesity related complications are anticipated in parallel. Bariatric surgery, a treatment approved for weight loss in morbidly obese patients, has reported to be associated with good outcomes, such as reversal of type two diabetes mellitus and reducing all-cause mortality on a long term basis. However, complications from bariatric surgery have similarly been reported. In particular, with the onslaught of non-alcoholic fatty liver disease (NAFLD) epidemic, in associated with obesity and metabolic syndrome, there is increasing prevalence of NAFLD related liver cirrhosis, which potentially connotes more risk of specific complications for surgery. Bariatric surgeons may encounter, either expectedly or unexpectedly, patients with non-alcoholic steatohepatitis (NASH) and NASH related cirrhosis more frequently. As such, the issues and considerations surrounding their medical care/surgery warrant careful deliberation to ensure the best outcomes. These considerations include severity of cirrhosis, liver synthetic function, portal hypertension and the impact of surgical factors. This review explores these considerations comprehensively and emphasizes the best approach to managing cirrhotic patients in the context of bariatric surgery.