Bariatric Surgery and Liver Transplantation: a Systematic Review a New Frontier for Bariatric Surgery

Abstract

This study aims to conduct a systematic review on bariatric surgery (BS) for patients in the setting of liver transplantation (LT). A literature review was conducted on the PubMed, Embase, and Cochrane Library databases. Studies in the English language on adults reporting on BS prior to, during, or after LT were included. Eleven studies with 56 patients were retrieved. Two studies reported on BS before, two during, and seven after LT. Sleeve gastrectomy was the most common procedure, followed by Roux-en-Y gastric bypass, biliopancreatic diversion, and gastric banding. The overall mortality rate was nil in the early postoperative period and 5.3 % in the first postoperative year. The reoperation rate was 12.2 %. Obesity surgery seems feasible in this population, but mortality and morbidity are higher.

Nonalcoholic fatty liver disease and bariatric surgery: a comprehensive review

“…However, it was also observed that episodes of transient renal failure, longer operation times and greater amounts of intraoperative bleeding and need for transfusion were more common within this group than in the general obese population. In a meta-analysis, Lazzati et al 168 observed a mean excess weight loss of 66% among morbidly obese cirrhotic individuals over a two-year period, which was comparable to the general population.…”

Bariatric surgery in individuals with liver cirrhosis: A narrative review

“…In a systematic review, Lazzati et al 21 found a 66% loss of excess weight within two years, comparable to that found in the general population. Vertical sleeve gastrectomy was the procedure conducted the most, and perioperative mortality was similar to that in the general population.…”

“…Morbidity is higher than in the general population (reoperation rate of up to 33%) but mortality is similar. 21,22,[28][29][30] conclusion…”

“…2,3 Performing bariatric surgery in non--compensated transplant candidates leads to higher morbidity and mortality, including the occurrence of anastomotic fistulas, which often reaches 12.5%. 21,22 Recently, there has been growing interest in the possibility of endoluminal treatments for obesity in individuals with high surgical risk. An endoscopic intragastric balloon implant in this group of patients, which is an attractive alternative, has presented satisfactory results in studies conducted by Choudhary et al 25 A case report by Campsen et al 26 showed the realization of adjustable gastric band implantation during a liver transplant had satisfactory results after 6 months.…”

“…On the other hand, this approach requires complex logistics (especially the concomitant availability of transplant and bariatric teams) and can combine serious complications that are not related to either procedure. 21,22,26,27 Therefore, in patients with non-compensated cirrhosis or with moderate to severe portal hyper- tension, conducting the liver transplantation first and bariatric surgery a posteriori is preferred. The clearest advantage of this option is the selection of patients who have had a favorable outcome after transplantation and developed or maintained obesity, now with improvements in hepatocyte function and portal hypertension.…”