Liver transplantation for subacute hepatocellular failure due to massive steatohepatitis after bariatric surgery.
New therapeutic options for obesity include restrictive bowel surgery and surgery that promotes malabsorption, such as the Fobi-Capella (gastric bypass) and Scopinaro (biliopancreatic diversion) techniques. Complications associated with these procedures, such as hepatocellular failure, have been observed with increasing frequency. Reported here are 3 patients who, 7 to 24 months after bariatric surgery, developed hepatocellular failure, for which liver transplantation was considered to be indicated. Liver transplantation was undertaken in 2 of the patients; the third patient died while waiting for this procedure. We discuss the possible causes of this uncommon and poorly understood complication of surgery for obesity. One possibility is that it might arise as a result of progression of steatohepatitis. An alternative concept is that this complication may be secondary to rapid, massive loss of body weight.
Department of General and Transplantation Surgery, Hospital Beneficência Portuguesa, São Paulo, SP, Brazil.
Luiz Augusto Carneiro
LA
D'Albuquerque
Adriano Miziara
AM
Gonzalez
Raul Carlos
RC
Wahle
Evandro
E
de Oliveira Souza
Jorge Marcelo Padilla
JM
Mancero
Adávio
A
de Oliveira e Silva
D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D001835:Body Weight; D017809:Fatal Outcome; D005234:Fatty Liver / Q000209:etiology / Q000628:therapy*; D005260:Female; D006505:Hepatitis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D017093:Liver Failure / Q000601:surgery / Q000628:therapy*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000379:methods*; D009765:Obesity / Q000601:surgery; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications; D013514:Surgical Procedures, Operative