Weight-loss surgery works for patients with compensated cirrhosis

Patients with compensated cirrhosis appear to benefit from bariatric surgery, which leads to sustained weight loss and stable hepatic function on long-term follow-up, a study has found.

The analysis included 10 patients followed over 8.7 years after bariatric surgery. Their mean age at the time of surgery was 58.4 years, and seven of them were female. All patients underwent sleeve gastrectomy, except for a single patient who received Roux-en-Y gastric bypass. There were no documented cases of perioperative or postoperative surgical complications or of perioperative mortality.

All patients had biopsy-proven nonalcoholic steatohepatitis (NASH), with two patients having concurrent, untreated hepatitis C infection. They lost a mean of 24 kg in weight (19.2 percent of total body weight presurgery; p<0.001) during the observation period. Only one patient regained weight to the baseline presurgical measurement.

In terms of complications, hepatic encephalopathy occurred in one patient who was not eligible for transplant 3 years after surgery; this patient later died. There were no cases of hepatic decompensation, cardiovascular event, or death recorded in the remaining nine patients.

At the last follow-up, bilirubin was normal in all patients, except for one who had Gilbert syndrome.

Despite the need for larger studies, the present findings indicate that the benefits of bariatric surgery may extend beyond NASH patients and apply to obese patients with other cirrhosis aetiologies, given the increased prevalence of obesity in patients with cirrhosis.