title: Laparoscopic Adjustable Gastric Banding In Patients with Unexpected Cirrhosis: Safety and Outcomes.
abstract: BACKGROUND
  The safety and efficacy of laparoscopic adjustable gastric banding (LAGB) in the context of cirrhosis have not been established. We hypothesized that LAGB in cirrhotic patients is a safe procedure that may offer positive long-term benefits, both in terms of obesity and avoiding progression of liver disease.
  
  
  METHODS
  Data were gathered from a prospectively maintained database of 8402 patients who had undergone LAGB from November 1993 and April 2014.
  
  
  RESULTS
  Fourteen patients with biopsy-proven cirrhosis were identified in the database. In all cases, cirrhosis was an unexpected macroscopic finding at the time of surgery, confirmed with intraoperative biopsy. All patients were either Child-Pugh A or B. No patients had preoperative clinical evidence of decompensated liver disease. The mean initial weight was 116.6 kg and BMI 38.9. There was no operative mortality. Two patients experienced a surgical complication (Clavien-Dindo grade II and grade IIIa). At 12 months, the mean excess weight loss was 61.3% giving a mean BMI 31.7. Repeat biopsies were available in three patients. All demonstrated improvement in inflammation and two had fibrosis regression. Baseline liver biochemistry was compared in nine patients who had repeat biochemistry studies after 12 months. There was a significant improvement in alanine transaminase (ALT) (p = 0.04) and aspartate transaminase (AST) (p = 0.02). Two patients developed hepatocellular carcinoma (HCC). One has died as a result of this disease 11 years after LAGB surgery.
  
  
  CONCLUSIONS
  LAGB may be a safe and effective bariatric intervention in patients with compensated cirrhosis. Our findings support the need for a prospective study with paired liver biopsies.
authors.affiliation: Centre for Obesity Research and Education, Monash University School of Public Health and Preventative Medicine, Level 6, 99 Commercial Road, Melbourne, VIC, 3004, Australia, richard.woodford@gmail.com.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Woodford
authors.forename: Paul R
authors.initials: PR
authors.lastname: Burton
authors.forename: Paul E
authors.initials: PE
authors.lastname: O'Brien
authors.forename: Cheryl
authors.initials: C
authors.lastname: Laurie
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Brown
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase