Influence of Liver Disease on Perioperative Outcome After Bariatric Surgery in a Northern German Cohort

TY - JOUR

T1 - Influence of Liver Disease on Perioperative Outcome After Bariatric Surgery in a Northern German Cohort

AU - Wolter, Stefan

AU - Duprée, Anna

AU - Coelius, Christina

AU - El Gammal, Alexander

AU - Kluwe, Johannes

AU - Sauer, Nina

AU - Mann, Oliver

PY - 2017/1

Y1 - 2017/1

N2 - OBJECTIVES: The aim of this study was to assess the prevalence of non-alcoholic fatty liver disease (NAFLD) in morbidly obese patients and evaluate the influence on perioperative complications.BACKGROUND: Patients undergoing bariatric surgery have a high incidence of non-alcoholic steatohepatitis (NASH). Upcoming data indicates that liver disease has a significant effect on perioperative complications. However, the influence of NAFLD/NASH on perioperative outcome in bariatric patients is still controversial.METHODS: We identified a total of 302 patients with concomitant liver biopsies, while performing either laparoscopic Roux-Y gastric bypass or sleeve gastrectomy. Liver biopsy was performed in case of abnormal liver appearance at time of bariatric surgery. Histological results were compared to perioperative complication rate.RESULTS: NAFLD is common in our patient cohort. Abnormal findings in liver histology were found in 82.3 % of our patients. Liver cirrhosis was newly diagnosed in 12 patients (4 %). There were no complications due to liver biopsy. The mortality rate was 0.3 %, leakage rate was 1 %, and postoperative bleeding occurred in 3.3 %. Pulmonary complications were observed in 1.7 % and cardiovascular complications in 1.3 %. One patient developed portal vein thrombosis and one patient acute pancreatitis; both were treated conservatively. No patient had postoperative liver failure. We found no association between histological findings and perioperative outcomes.CONCLUSIONS: The prevalence of NAFLD among morbidly obese surgical patients was high, although this condition was not associated with increased risk for postoperative complications. Because of unexpected findings in intraoperative liver biopsies, the routine indication of liver biopsies in patients at high risk for liver disease should be discussed.

AB - OBJECTIVES: The aim of this study was to assess the prevalence of non-alcoholic fatty liver disease (NAFLD) in morbidly obese patients and evaluate the influence on perioperative complications.BACKGROUND: Patients undergoing bariatric surgery have a high incidence of non-alcoholic steatohepatitis (NASH). Upcoming data indicates that liver disease has a significant effect on perioperative complications. However, the influence of NAFLD/NASH on perioperative outcome in bariatric patients is still controversial.METHODS: We identified a total of 302 patients with concomitant liver biopsies, while performing either laparoscopic Roux-Y gastric bypass or sleeve gastrectomy. Liver biopsy was performed in case of abnormal liver appearance at time of bariatric surgery. Histological results were compared to perioperative complication rate.RESULTS: NAFLD is common in our patient cohort. Abnormal findings in liver histology were found in 82.3 % of our patients. Liver cirrhosis was newly diagnosed in 12 patients (4 %). There were no complications due to liver biopsy. The mortality rate was 0.3 %, leakage rate was 1 %, and postoperative bleeding occurred in 3.3 %. Pulmonary complications were observed in 1.7 % and cardiovascular complications in 1.3 %. One patient developed portal vein thrombosis and one patient acute pancreatitis; both were treated conservatively. No patient had postoperative liver failure. We found no association between histological findings and perioperative outcomes.CONCLUSIONS: The prevalence of NAFLD among morbidly obese surgical patients was high, although this condition was not associated with increased risk for postoperative complications. Because of unexpected findings in intraoperative liver biopsies, the routine indication of liver biopsies in patients at high risk for liver disease should be discussed.

KW - Adult

KW - Bariatric Surgery

KW - Biopsy

KW - Female

KW - Humans

KW - Liver Cirrhosis

KW - Male

KW - Middle Aged

KW - Non-alcoholic Fatty Liver Disease

KW - Obesity, Morbid

KW - Perioperative Period

KW - Postoperative Complications

KW - Prevalence

KW - Retrospective Studies

KW - Treatment Outcome

KW - Journal Article

U2 - 10.1007/s11695-016-2253-6

DO - 10.1007/s11695-016-2253-6

M3 - SCORING: Journal article

C2 - 27272667

VL - 27

SP - 90

EP - 95

JO - OBES SURG

JF - OBES SURG

SN - 0960-8923

IS - 1

ER -