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2017; 63(2):190-194
REVIEW ARTICLE
Bariatric surgery in individuals with liver cirrhosis:
A narrative review
E
verton
C
azzo
1
*, M
artinho
A
ntonio
G
estic
2
, M
urillo
P
imentel
U
trini
3
, F
elipe
D
avid
M
endonça
C
haim
2
,
F
rancisco
C
allejas
-N
eto
4
, J
osé
C
arlos
P
areja
5
, E
linton
A
dami
C
haim
6
1
MD, PhD, Assistant Lecturer, Department of Surgery, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
2
MD, MSc, Assistant Lecturer, Department of Surgery, Faculdade de Ciências Médicas, Unicamp, Campinas, SP, Brazil
3
MD, Assistant Lecturer, Department of Surgery, Faculdade de Ciências Médicas, Unicamp, Campinas, SP, Brazil
4
MD, MSc, Associate Professor, Department of Surgery, Faculdade de Ciências Médicas, Unicamp, Campinas, SP, Brazil
5
MD, PhD, Associate Professor, Department of Surgery, Faculdade de Ciências Médicas, Unicamp, Campinas, SP, Brazil
6
MD, PhD, Full Professor, Department of Surgery, Faculdade de Ciências Médicas, Unicamp, Campinas, SP, Brazil
S
ummary
Study conducted at Department of
Surgery, Faculdade de Ciências Médicas,
Universidade Estadual de Campinas
(Unicamp), Campinas, SP, Brazil
Article received:
6/23/2016
Accepted for publication:
6/26/2016
*Correspondence:
Departamento de Cirurgia, Unicamp
Address: R. Alexander Fleming, s/n
Campinas, SP – Brazil
Postal code: 13083-887
notrevezzo@yahoo.com.br http://dx.doi.org/10.1590/1806-9282.63.02.190Introduction:
Bariatric surgery has become the gold standard treatment for
morbid obesity, but there is no consensus regarding its safety and efficacy among
individuals with chronic liver diseases.
Objective:
To critically evaluate the existing evidence on literature about bariatric
surgery in individuals with liver cirrhosis.
Method:
Narrative review performed by means of an online search in the
MEDLINE and LILACS databases.
Results
: Bariatric surgery is safe and effective in individuals with chronic liver
disease without clinical decompensation or significant portal hypertension.
Individuals with severe liver function impairment present significantly higher
surgical morbidity and mortality. Among candidates to liver transplantation,
surgery may be performed before, after and even during transplantation, and
there is a predominant trend to perform it after. Vertical sleeve gastrectomy seems
to be the most adequate technique in this group of subjects.
Conclusion:
Bariatric surgery is safe and effective in individuals with compensated
cirrhosis without significant portal hypertension, but presents higher morbidity.
Among candidates to liver transplantation and/or individuals with severe portal
hypertension, morbidity and mortality are significantly higher.
Keywords:
liver diseases, obesity, bariatric surgery, liver cirrhosis, liver transplantation.
I
ntroduction
Since the second half of the 20
th
century, the world has
seen a significant increase in the prevalence of overweight
and obesity. According to the World Health Organiza-
tion (WHO), there are more than 1.4 billion adults over
their ideal weight, including more than 200 million men
and almost 300 million women that are obese. Cur-
rently, 65% of the world’s population lives in countries
where obesity and overweight are responsible for more
deaths than malnutrition.
1
Likewise, the prevalence of obesity among cirrhotic
individuals who are candidates for liver transplantation
has almost doubled since the 1990s, reaching more than
30%.
2,3
Furthermore, obesity and metabolic syndrome
have presented an increasingly significant causal relation-
ship with chronic liver disease.
4
Non-alcoholic fatty liver
disease (NAFLD) is currently the third leading cause of
liver transplantation in the United States of America
(USA). Also, there is evidence that, if suitable diagnostic
criteria are applied, about 2/3 of cases characterized as
cryptogenic cirrhosis are actually caused by NAFLD.
5,6
It
is predicted that in 2030, NAFLD will be the leading cause
of liver transplantation in the USA.
7
In recent years, bariatric surgery has become the gold
standard treatment for morbid obesity, leading to better
results compared to clinical treatment.
8
However, among
obese patients with chronic liver disease, there is no con-
sensus regarding the most effective and safest therapeutic