title: Bariatric surgery in patients with liver cirrhosis.
abstract: BACKGROUND
  Data regarding the management of bariatric patients with cirrhosis are scarce, and there is no strong evidence that supports a specific approach for this group of patients. The aim of this study was to review our experience with cirrhotic patients undergoing bariatric surgery.
  
  
  METHODS
  A prospectively maintained database was reviewed to assess the outcomes of bariatric surgery for patients with known cirrhosis and for patients with cirrhosis discovered at surgery (unknown cirrhosis).
  
  
  RESULTS
  From April 2004 to September 2011, 23 patients (12 with known cirrhosis and 11 with unknown cirrhosis) met inclusion criteria. There were 14 females and 9 males with a mean age of 51.5 ± 8.3 and a mean body mass index of 48.2 ± 8.6 kg/m2. Child-Pugh classes were A (n = 22) and B (n = 1). Patients had a high frequency of diabetes (83%), dyslipidemia (61%), and hypertension (83%). Procedures performed were laparoscopic Roux-en-Y gastric bypass (LRYGB) (n = 14), laparoscopic sleeve gastrectomy (LSG) (n = 8), and laparoscopic adjustable gastric banding (n = 1). Two patients underwent LSG successfully after transjugular intrahepatic portosystemic shunt. Mean length of hospital stay was 4.3 ± 2.7 days. Complications developed in 8 patients. One patient died of unknown cause 9 months after surgery. No patients had liver decompensation after surgery. The patients lost 67.4% ± 30.9% of their excess weight at 12 months follow-up and 67.7% ± 24.8% at 37 months follow-up.
  
  
  CONCLUSIONS
  LRYGB and LSG can be performed without prohibitive complication rates in carefully selected patients with cirrhosis. In our experience, bariatric patients with cirrhosis achieved excellent weight loss and improvement in obesity-related co-morbidities.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Hideharu
authors.initials: H
authors.lastname: Shimizu
authors.forename: Viet
authors.initials: V
authors.lastname: Phuong
authors.forename: Munique
authors.initials: M
authors.lastname: Maia
authors.forename: Matthew
authors.initials: M
authors.lastname: Kroh
authors.forename: Bipan
authors.initials: B
authors.lastname: Chand
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss