title: Safety and feasibility of sleeve gastrectomy in morbidly obese patients following liver transplantation.
abstract: BACKGROUND
  Obesity, steroid-induced diabetes, hypercholesterolemia, and steatohepatitis can occur after liver transplantation and may respond to bariatric surgery. The safety and feasibility of bariatric surgery after liver transplantation is unknown.
  
  
  METHODS
  Nine morbidly obese patients with prior liver transplants underwent sleeve gastrectomy in a pilot program. Sleeve gastrectomy was chosen over gastric banding to avoid foreign body implantation, and over gastric bypass to maintain endoscopic access to the biliary system and reduce surgical complexity. We reviewed patient demographics, operative details, 30-day complications, weight loss, postoperative hepatic and renal functions, and resolution of comorbidities.
  
  
  RESULTS
  Sleeve gastrectomy was performed laparoscopically in eight patients and as an open procedure in one patient. The mean operative time was 165 min and mean postoperative length of stay was 5 days. Follow-up ranged from 3 to 36 months. In the first 30 days, there were three complications in three patients: mesh dehiscence after a synchronous incisional hernia repair, bile leak from the liver surface requiring laparoscopic drainage, and postoperative dysphagia that required reoperation. Calcineurin inhibitor levels and hepatic and renal functions remained stable. There were no episodes of graft rejection. At 3 months liver function tests remained stable. Excess weight loss averaged 55.5% at 6 months.
  
  
  CONCLUSIONS
  Sleeve gastrectomy is technically feasible after liver transplantation and resulted in weight loss without adversely affecting graft function and immunosuppression. Early complications may be more frequent as a result of adhesions of the left upper quadrant. Late complications were rare.
authors: Department of Surgery, University of California, San Francisco, School of Medicine, San Francisco, CA 94143, USA. matthewlin98@yahoo.com
authors: Matthew Y C
authors: MY
authors: Lin
authors: M Mehdi
authors: MM
authors: Tavakol
authors: Ankit
authors: A
authors: Sarin
authors: Shadee M
authors: SM
authors: Amirkiai
authors: Stanley J
authors: SJ
authors: Rogers
authors: Jonathan T
authors: JT
authors: Carter
authors: Andrew M
authors: AM
authors: Posselt
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000601:surgery*; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology; D000267:Tissue Adhesions / Q000209:etiology; D015431:Weight Loss
chemical_list: D015415:Biomarkers