Bariatric surgery in individuals with liver cirrhosis: A narrative review

Abstract

Summary Introduction: Bariatric surgery has become the gold standard treatment for morbid obesity, but there is no consensus regarding its safety and efficacy among individuals with chronic liver diseases. Objective: To critically evaluate the existing evidence on literature about bariatric surgery in individuals with liver cirrhosis. Method: Narrative review performed by means of an online search in the MEDLINE and LILACS databases. Results: Bariatric surgery is safe and effective in individuals with chronic liver disease without clinical decompensation or significant portal hypertension. Individuals with severe liver function impairment present significantly higher surgical morbidity and mortality. Among candidates to liver transplantation, surgery may be performed before, after and even during transplantation, and there is a predominant trend to perform it after. Vertical sleeve gastrectomy seems to be the most adequate technique in this group of subjects. Conclusion: Bariatric surgery is safe and effective in individuals with compensated cirrhosis without significant portal hypertension, but presents higher morbidity. Among candidates to liver transplantation and/or individuals with severe portal hypertension, morbidity and mortality are significantly higher.

Nutrition in Chronic Liver Disease: Consensus Statement of the Indian National Association for Study of the Liver

“…Morbidity and mortality in patients with cirrhosis undergoing bariatric surgery is higher than patients without cirrhosis and further increases in patients with decompensated cirrhosis. 284,285 Thus, the decision to perform bariatric surgery before, during and after liver transplantation in patients with decompensated cirrhosis has to be individualized. [286][287][288][289] Dietary modification and exercise are the cornerstone of management of patients with NASH.…”