Results of Laparoscopic Gastric Bypass in Patients with Cirrhosis (original) (raw)

Background: The safety and efficacy of bariatric surgery in patients with cirrhosis has not been well studied. Methods: A retrospective review was conducted of patients with cirrhosis who underwent weight-loss surgery at a single institution. Results: Out of a total of 2,119 patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGBP), 30 patients (1.4%) with cirrhosis were identified.When compared with the entire cohort, patients with cirrhosis were significantly more prone to be heavier (BMI 53 vs 48), older in years (age 50 vs 45), more likely to be male (RR=1.3), and have a higher incidence of diabetes (70% vs 21%) and hypertension (67% vs 21%), P<0.05. The diagnosis of cirrhosis was made intra-operatively in 90% of patients. There were no perioperative deaths, conversions to laparotomy, or liver-related complications. Early complications occurred in 9 patients and included anastomotic leak (1), acute tubular necrosis (4), prolonged intubation (2), ileus (1), and blood transfusion (2). Mean length of hospital stay was 4 days (2-18). There was one late unrelated death and one patient with prolonged nausea and protein malnutrition. The average follow-up time was 16 months (1-48). For patients >12 months postoperatively (n=15), the average percent excess weight loss was 63±15%. Conclusion: Laparoscopic RYGBP in the cirrhotic patient has an acceptable complication rate and achieves satisfactory early weight loss. Patients tend to be heavier, older, male and more likely to have diabetes and hypertension. Long-term studies are necessary to examine how weight loss impacts established cirrhosis.

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Authors and Affiliations

1. The University of Pittsburgh, Department of Surgery, Pittsburgh, PA, USA
   Ramsey M Dallal MD
2. The University of Pittsburgh, Department of Surgery, Pittsburgh, PA, USA
   Samer G Mattar MD
3. The University of Pittsburgh, Department of Surgery, Pittsburgh, PA, USA
   Jeffrey L Lord MD
4. The University of Pittsburgh, Department of Surgery, Pittsburgh, PA, USA
   Andrew R Watson MD
5. The University of Pittsburgh, Department of Surgery, Pittsburgh, PA, USA
   Daniel R Cottam MD
6. The University of Pittsburgh, Department of Surgery, Pittsburgh, PA, USA
   George M Eid MD
7. The University of Pittsburgh, Department of Surgery, Pittsburgh, PA, USA
   Giselle Hamad MD
8. The University of Pittsburgh, Department of Surgery and Gastroenterology, Pittsburgh, PA, USA
   Mordecai Rabinovitz MD
9. The University of Pittsburgh, Department of Surgery, Pittsburgh, PA, USA
   Philip R Schauer MD

Authors

1. Ramsey M Dallal MD
2. Samer G Mattar MD
3. Jeffrey L Lord MD
4. Andrew R Watson MD
5. Daniel R Cottam MD
6. George M Eid MD
7. Giselle Hamad MD
8. Mordecai Rabinovitz MD
9. Philip R Schauer MD

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Dallal, R.M., Mattar, S.G., Lord, J.L. et al. Results of Laparoscopic Gastric Bypass in Patients with Cirrhosis.OBES SURG 14, 47–53 (2004). https://doi.org/10.1381/096089204772787284

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• Published: 01 January 2004
• Issue date: January 2004
• DOI: https://doi.org/10.1381/096089204772787284