Significant Liver-Related Morbidity After Bariatric Surgery and Its Reversal-a Case Series - PubMed (original) (raw)

Magdalena Eilenberg et al. Obes Surg. 2018 Mar.

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) occurs in up to 80% of patients with obesity. Current data suggest an improvement of NAFLD after established bariatric procedures.

Objectives: This study investigated liver function impairment after Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB).

Setting: University Hospital, Bariatric Surgery Unit METHODS: In this single-center case series, consecutive in- and outpatients after bariatric surgery who presented with severe liver dysfunction from March 2014 to February 2017 were included and followed until March 2017.

Results: In total, 10 patients (m:f = 2:8; median age 48 years, range 22-66 years) were included. Liver dysfunction occurred after a median postoperative time of 15 months (range 2-88 months). Median %excess weight loss at that time was 110.6% (range 85.2-155.5%). Liver steatosis/fibrosis occurred in 70%, cirrhosis in 30% of patients, and led to fatigue (90%), ascites (70%), hepatic encephalopathy (30%), and upper gastrointestinal bleeding (20%). Elevation of transaminases, impairment of coagulation parameters, thrombocytopenia, and hypoalbuminemia were present in 70, 80, 70, and 100%, respectively. In eight patients, lengthening of the alimentary/common limb led to an improvement or complete remission of symptoms. In one patient, liver transplantation was required, one patient deceased due to septic shock and decompensated liver disease.

Conclusions: Severe liver dysfunction may also occur after bariatric procedures such as OAGB and RYGB. A comprehensive, meticulous follow-up for early identification of postoperative liver impairment should be aspired. Bypass length reduction led to a fast improvement in all patients.

Keywords: Bypass reversal; Liver dysfunction; NAFLD; Weight loss.

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Conflict of interest statement

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Statement

All procedures performed in this study were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all study participants where applicable.

Figures

Fig. 1

Fig. 1

Histopathological findings of liver biopsy and the corresponding clinical course of patient 1 and 2. Patient #1 (1A–E): 1A (hematoxylin-eosin [HE] staining, ×8 magnification [mag.]) and 1B (chromotrop-aniline blue [CAB] staining, ×20 mag.): histology gained at time of feeding-tube implantation; steatosis (95% macrovesicular, 5% microvesicular) with partly periportal fibrosis und minor inflammatory activity, correlating with NASH, NA-Score: 3-1-1 (5/8), fibrosis grade 1C. 1C (HE staining, ×10 mag.), and 1D (CAB staining ×20 mag.): histology gained 5 months after bypass reversal: portal and periportal fibrosis, incipient portoportal septation. No micro- or macrovesicular steatosis, no inflammatory activity, no hepatocellular ballooning. 1E: laboratory-values and clinical events over time. Patient #2 (2A–E): 2A (HE staining, ×8 mag.): histology gained after explantation of the gastric band: liver tissue with broad, septal fibrosis and starting, focal cirrhotic alteration, no inflammatory activity, corresponding to resolved NASH. 2B (CAB staining, ×20 mag.): histology gained after OAGB: focal cirrhosis, pericellular fibrosis, and moderate steatosis (20% micro-, 5% macrovesicular). 2C (HE staining, ×8 mag.): histology gained at time of liver transplantation (LT): liver cirrhosis and siderosis, marginal irregular steatosis (10% microvesicular), Ludwig-Score: portal: 2, lobular: 1, fibrosis grade 4. 2D (CAB staining, ×20 mag.): histology gained 4 months after LT: hepatic picture with minor inflammatory activity, cholestasis, and focal portoportal fibrosis. 2E: laboratory values and clinical events over time

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