Bariatric surgery in patients with cirrhosis with and without portal hypertension: A single-center experience

Laura Pestana, James Swain, Ross Dierkhising, Michael L. Kendrick, Patrick Sequeira Kamath, Kymberly D. Watt

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)209-215
Number of pages7
JournalMayo Clinic Proceedings
Volume90
Issue number2
DOIs
StatePublished - Feb 1 2015

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Bariatric Surgery
Portal Hypertension
Fibrosis
Digestive System Endoscopy
Gastric Bypass
Liver
Brain Diseases
Gastrectomy
Bilirubin
Weight Loss
Ultrasonography
Referral and Consultation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Bariatric surgery in patients with cirrhosis with and without portal hypertension : A single-center experience. / Pestana, Laura; Swain, James; Dierkhising, Ross; Kendrick, Michael L.; Kamath, Patrick Sequeira; Watt, Kymberly D.

In: Mayo Clinic Proceedings, Vol. 90, No. 2, 01.02.2015, p. 209-215.

Research output: Contribution to journalArticle

Pestana, Laura ; Swain, James ; Dierkhising, Ross ; Kendrick, Michael L. ; Kamath, Patrick Sequeira ; Watt, Kymberly D. / Bariatric surgery in patients with cirrhosis with and without portal hypertension : A single-center experience. In: Mayo Clinic Proceedings. 2015 ; Vol. 90, No. 2. pp. 209-215.
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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.",
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