Outcomes of bariatric surgery in the setting of compensated advanced chronic liver disease associated with clinically significant portal hypertension: a multicenter, retrospective, cohort study on feasibility and safety.

Autor:	Temime V; Centre Hospitalier Universitaire de Nice-Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice., Ghanem OM; Department of Surgery., Heimbach JK; Division of Transplantation, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA., Diwan TS; Division of Transplantation, Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA., Tranchart H; Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, Clamart; Paris-Saclay University, Orsay., Abdallah H; Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, Clamart; Paris-Saclay University, Orsay., Blanchard C; Clinique de chirurgie cancérologique, digestive et endocrinienne, institut des maladies de l'appareil digestif (IMAD), CHU de Nantes; CHU de Nantes, l'institut du thorax, Nantes université, CNRS, Inserm, Nantes., Lontrichard M; Clinique de chirurgie cancérologique, digestive et endocrinienne, institut des maladies de l'appareil digestif (IMAD), CHU de Nantes; CHU de Nantes, l'institut du thorax, Nantes université, CNRS, Inserm, Nantes., Reche F; Univesity Grenoble Alpes, Department of Digestive Surgery., Borel AL; Department of Endocrinology Diabetology Nutrition, Grenoble Alpes University Hospital, Centre Spécialisé de l'Obésité Grenoble Arc Alpin, Grenoble, France., Belluzzi A; Bariatric Surgery Unit, University of Padua, Padua., Foletto M; Bariatric Surgery Unit, University of Padua, Padua., Manno E; AORN A. Cardarelli Napoli, UO Chirurgia Bariatrica e Metabolica, Napoli, Italy., Poghosyan T; Université Paris Cité, AP-HP.Nord, Hôpital Bichat Claude Bernard, Service de Chirurgie Digestive UMR 1149, Inserm, Paris., Chierici A; Centre Hospitalier Universitaire de Nice-Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice., Iannelli A; Université Côte d'Azur, Nice.; Inserm, U1065, Team 8 'Hepatic complications of obesity and alcohol'.; ADIPOCIBLE Study Group.
Jazyk:	angličtina
Zdroj:	International journal of surgery (London, England) [Int J Surg] 2024 Jun 01; Vol. 110 (6), pp. 3562-3570. Date of Electronic Publication: 2024 Jun 01.
DOI:	10.1097/JS9.0000000000001310
Abstrakt:	Background: The obesity epidemic has led to an increase in the proportion of patients with chronic liver disease due to metabolic associated steatosic liver disease and in the prevalence of obesity in patients with cirrhosis. Metabolic and bariatric surgery (MBS) has been proven to determine weight loss, obesity-related medical problems remission, and liver steatosis, inflammation, and fibrosis improvement. However, cirrhosis and portal hypertension are well-known risk factors for increased morbidity and mortality after surgery. The aim of this study is to evaluate the safety of MBS in patients with compensated advanced chronic liver disease (cALCD) and clinically significant portal hypertension (CSPH). Material and Methods: This is an international, multicentric, retrospective study on 63 individuals affected by obesity with cALCD and CSPH who underwent MBS in tertiary referral centers with experts hepatobiliary surgeons between January 2010 and October 2022. The primary endpoint was postoperative mortality at 90 days. The secondary endpoints included postoperative weight loss at last follow-up and postoperative complication rate. In addition, the authors performed subgroup analyses of Child-Pugh (A vs. B) score, MELD (≤9 vs. >9) score, and type of surgery. Results: One patient (1.6%) experienced gastric leakage and mortality. There were three (5%) reported cases of portal vein thrombosis, two (3%) postoperative acute renal failure, and one (1.6%) postoperative encephalopathy. Child-Pugh score A resulted to be a protective factor for intraoperative bleeding requiring transfusion at univariate analysis (OR: 0.73, 95% CI: 0.55-0.97, P =0.046) but not at multivariate analysis. MELD>9 score and the type of surgery did not result to be a risk factor for any postoperative complication. Conclusion: MBS is safe in patients with cALCD and CSPH performed in tertiary bariatric referral centers with hepatobiliary expert surgeons. Larger, prospective studies with longer follow-up periods are needed to confirm these results. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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