Clinical hepatic impairment after the duodenal switch.
BACKGROUND
Nonalcoholic steatohepatitis (NASH) is the most common histological finding in morbidly obese patients undergoing liver biopsy. Biliopancreatic diversion has been widely used for the treatment of morbid obesity and hepatic steatosis, and very few cases of liver impairment as a complication of this operation have been reported.


METHODS
During the last 9 years, 470 morbidly obese patients were operated by means of a biliopancreatic diversion with duodenal switch ( BPD-DS), and 93 of them were performed laparoscopically.


RESULTS
10 cases of clinical hepatic impairment occurred after the BPD-DS. The clinical course of these patients ranged from transient subclinical alterations of liver function tests to severe cases of jaundice and one death from liver failure.


CONCLUSIONS
Randomized prospective studies with standardization of BPD-DS are needed, to know the real incidence of hepatic impairment and the proper treatment for this condition. Careful follow-up and correction of possible malnutrition should be addressed to avoid hepatic impairment and/or progression of liver disease.
General Surgical Service, "Virgen de los Lirios" Hospital, Alcoy, Alicante, Spain. abaltasar@seco.org
Aniceto
A
Baltasar
Carlos
C
Serra
Nieves
N
Pérez
Rafael
R
Bou
Marcelo
M
Bengochea
D000328:Adult; D015904:Biliopancreatic Diversion / Q000379:methods*; D015992:Body Mass Index; D005234:Fatty Liver / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007565:Jaundice / Q000209:etiology*; D010535:Laparoscopy; D017093:Liver Failure / Q000209:etiology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome