title: Bariatric surgery in patients with cirrhosis with and without portal hypertension: a single-center experience.
abstract: OBJECTIVE
  To assess safety and outcomes (metabolic and liver) of bariatric surgery in patients with cirrhosis with or without portal hypertension.
  
  
  METHODS
  This study is a retrospective review of 14 patients with Child's A cirrhosis with or without portal hypertension who were prospectively enrolled from February 23, 2009, through November 9, 2011, with 6- to 24-month follow-up after bariatric surgery (11 patients underwent sleeve gastrectomy [78.6%] and 3 gastric bypass [21.4%]). Four patients had portal hypertension detected by esophagogastroduodenoscopy.
  
  
  RESULTS
  The mean patient age was 55.5 years, and 10 of 14 patients were women. The mean weight decreased from 125±18 to 94±17 at 1 year (P<.001) and 93±17 kg at 2 years (P<.001) postsurgery. The prevalence of diabetes decreased from 10 of 14 patients to 4 of 12 (P=.01) and 1 of 6 (P=.02) at 1 and 2 years postsurgery. The frequency of dyslipidemia and hypertension decreased but was not statistically significant; however, the number of medications required to control them decreased. Hepatic steatosis was detected by perioperative liver biopsy in 13 of 14 patients (5%-30% steatosis in 6 patients, 31%-60% in 6, and >60% in 1). At 1 year postsurgery, only 1 of 8 patients who underwent follow-up ultrasound imaging showed evidence of steatosis. The bilirubin level was above 2 mg/dL in 1 patient at 1 year postsurgery. One patient had encephalopathy at 2 years postsurgery. None of the patients developed peri- or postoperative bleeding or surgical complications.
  
  
  CONCLUSIONS
  Bariatric surgery in patients with compensated cirrhosis even with mild portal hypertension is well tolerated and safe with minimal risk of postoperative complications if performed in a large referral center. This population can experience the beneficial effects of weight loss and improved metabolic syndrome, as well as reduced hepatic steatosis.
authors: Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors: Laura
authors: L
authors: Pestana
authors: Department of Surgery, Mayo Clinic, Rochester, MN.
authors: James
authors: J
authors: Swain
authors: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors: Ross
authors: R
authors: Dierkhising
authors: Department of Surgery, Mayo Clinic, Rochester, MN.
authors: Michael L
authors: ML
authors: Kendrick
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors: Patrick S
authors: PS
authors: Kamath
authors: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. Electronic address: watt.kymberly@mayo.edu.
authors: Kymberly D
authors: KD
authors: Watt
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D016145:Endoscopy, Digestive System; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000601:surgery; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies