RAMB - Fevereiro 2017

ariatric

surgery

individuals

with

liver

cirrhosis

: A

narrative

review

ssoc

ras

2017; 63(2):190-194

193

tension, conducting the liver transplantation first and

bariatric surgery

a posteriori

is preferred. The clearest ad-

vantage of this option is the selection of patients who

have had a favorable outcome after transplantation and

developed or maintained obesity, now with improvements

in hepatocyte function and portal hypertension. Morbid-

ity is higher than in the general population (reoperation

rate of up to 33%) but mortality is similar.

21,22,28-30

onclusion

In individuals with liver disease and preserved hepato-

cytic function and without significant portal hypertension,

bariatric surgery is an effective and safe therapeutic option,

with results close to those of patients without liver disease.

In these cases, the techniques used the most are vertical

sleeve gastrectomy and Roux-en-Y gastric bypass. In pa-

tients with severe liver diseases, candidates for transplan-

tation or post-transplant patients, the most appropriate

technique is vertical sleeve gastrectomy. Performing sur-

gery prior to transplantation is significantly worse than

in the general population and should be avoided. Con-

sidering the current encouraging results of liver trans-

plantation in obese patients, the post-transplant approach

seems to be the most appropriate. The realization of pro-

spective controlled studies with large samples is required

so that we can obtain more definitive conclusions.

onflict

interest

The authors declare no conflict of interest.

esumo

Cirurgia bariátrica em indivíduos com cirrose hepática:

uma revisão narrativa

Introdução:

A cirurgia bariátrica tornou-se nos últimos

anos o tratamento padrão-ouro para a obesidade mórbida;

porém, entre obesos portadores de hepatopatia crônica, não

existe consenso a respeito de sua segurança e efetividade.

Objetivo:

Análise crítica da literatura existente sobre a

realização de cirurgia bariátrica em portadores de cir-

rose hepática.

Método:

Revisão narrativa por meio de pesquisa

online

nas bases de dados Medline e Lilacs.

Resultados:

As cirurgias bariátricas em indivíduos cirró-

ticos sem descompensação clínica levam a resultados sa-

tisfatórios. Já indivíduos comhepatopatia grave apresentam

morbidade perioperatória e mortalidade significativamen-

te maiores do que as observadas na população obesa sem

hepatopatia. Em candidatos a transplante hepático, a ci-

rurgia pode ser realizada antes, durante ou após o trans-

plante, havendo uma tendência predominante à realização

após o transplante. A gastrectomia vertical parece ser a

técnica mais adequada nesse grupo de pacientes.

Conclusão:

A cirurgia bariátrica é segura e efetiva em

portadores de cirrose hepática compensada e sem hiper-

tensão portal; porém, apresenta maior morbidade. Em

candidatos a transplante e/ou indivíduos com hiperten-

são portal significativa, a morbimortalidade é significa-

tivamente maior.

Palavras-chave:

hepatopatias, obesidade, cirurgia bariá-

trica, cirrose hepática, transplante de fígado.

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