Safety and efficacy of bariatric surgery in patients with advanced fibrosis

Bariatric surgery is performed safely in non-alcoholic fatty liver disease (NAFLD) patients with minimal fibrosis (stage 1-2). However, the safety and potential benefits of bariatric surgery for NAFLD with advanced fibrosis (stage 3-4) remain unclear. This study was designed to compare the safety an...

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Bibliographic Details
Published in:	International Journal of Obesity 2017-03, Vol.41 (3), p.443-449
Main Authors:	Singh, T, Kochhar, G S, Goh, G B, Schauer, P, Brethauer, S, Kroh, M, Aminian, A, Lopez, R, Dasarathy, S, McCullough, A J
Format:	Article
Language:	eng
Subjects:	Alanine Alanine transaminase Alanine Transaminase - blood Aspartate Aspartate aminotransferase Bariatric surgery Bariatric Surgery - adverse effects Bariatric Surgery - methods Biomarkers - blood Biopsy Body mass Body mass index Body size Care and treatment Complications Complications and side effects Development and progression Diagnosis Evidence-Based Medicine Fatty liver Female Fibrosis Fish oils Follow-Up Studies Gastrointestinal surgery Humans Inflammation - epidemiology Inflammation - etiology Inflammation - pathology Length of stay Length of Stay - statistics & numerical data Liver Liver - pathology Liver diseases Male Middle Aged Non-alcoholic Fatty Liver Disease - complications Non-alcoholic Fatty Liver Disease - pathology Obesity Obesity, Morbid - complications Obesity, Morbid - pathology Obesity, Morbid - surgery Patient outcomes Patient Selection Patients Physiological aspects Postoperative Postoperative Complications - epidemiology Postoperative Complications - pathology Risk Factors Safety Safety and security measures Severity of Illness Index Surgery Transaminase Transaminases United States
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Summary:	Bariatric surgery is performed safely in non-alcoholic fatty liver disease (NAFLD) patients with minimal fibrosis (stage 1-2). However, the safety and potential benefits of bariatric surgery for NAFLD with advanced fibrosis (stage 3-4) remain unclear. This study was designed to compare the safety and efficacy of bariatric surgery in patients with biopsy proven advanced fibrosis to those with minimal fibrosis. All patients who underwent bariatric surgery between 2005 and 2014 and had evidence of NAFLD with fibrosis score 3-4 (advanced fibrosis) based on the staging system defined by Kleiner et al. on intraoperative liver biopsy were included and compared with patients who had fibrosis score 1-2 (minimal fibrosis). The groups were compared for length of hospital stay after bariatric surgery and incidence of postoperative complications over a follow-up period of 1 year. An improvement in hepatic function tests before and 1 year after surgery was used as a parameter to evaluate for NAFLD improvement. Ninety-nine patients with F3-4 (group 1) and 198 patients with F1-2 (group 2) were included. Mean age (51.9 vs 50.1 years) and body mass index (46.4 vs 46.5 kg m ) were similar in the two groups. Median serum aspartate aminotransferase (43 vs 30 U l ; normal 10-40 U l ) and alanine aminotransferase (40.5 vs 34 U l ; normal 10-50 U l ) were significantly higher in group 1 and improved 1 year after surgery. Median length of hospital stay after surgery was higher in group 1 than that in group 2 (4 days vs 3 days; P-value=0.002). The proportion of patients developing postoperative complications over 1 year was similar in both groups (36.4% vs 32.8%; P-value=0.54). Advanced fibrosis does not increase the risk of developing postoperative complications in medically optimized patients undergoing bariatric surgery. Improvement in serum transaminase levels suggests a reduction in hepatic necroinflammatory activity following bariatric surgery.
ISSN:	0307-0565 1476-5497