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BARIATRIC SURGERY IN PATIENTS WITH COMPENSATED CIRRHOSIS HAS EXCELLENT SAFETY AND EFFICACY
Marshall E. McCabe*1, Eduardo Vilar-Gomez1, Marwan S. Ghabril1, Ambar Banerjee2, Dimitrios Stefanidis2, Don J. Selzer2, Naga P. Chalasani1
1Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN; 2Bariatric Surgery, Indiana University School of Medicine, Indianapolis, IN
Background: Bariatric surgery may have a positive impact on the natural history of patients with cirrhosis. Available data on the safety and efficacy of bariatric surgery in patients with cirrhosis is limited and showed mixed results.
Aim: To examine the safety and efficacy of foregut bariatric surgery in patients with cirrhosis.
Methods: We conducted a case-control study of individuals who underwent foregut bariatric surgery at our institution during 2010-2015. The presence of cirrhosis was identified based on predefined criteria consisting of clinical, imaging, histological, or validated predictive criteria per Mittal et al (CGH 2016; 14: 124-131). Patients with cirrhosis (cases) were compared to age, gender, BMI, and type of bariatric surgery matched individuals without cirrhosis (controls) in a 1:3 manner. Outcomes of interest were length of stay, postoperative complications, and mortality and weight loss up to 12 months.
Results: During the study period, 1272 patients underwent bariatric surgery at our institution and 43 individuals met the definition of cases whereas 129 matched individuals served as controls. Of 43 cases, 11 had known cirrhosis whereas others were identified incidentally at surgery or defined based on Mittal criteria. Mean (± SD) preoperative MELD was 10.5 ± 4.9 and 93%, Child-Pugh class A cirrhosis, and 1 had preoperative TIPS. Roux-en-Y was performed in 67% and sleeve gastrectomy in 30%. Only 1 patient developed decompensation following surgery and occurred between months 6-12. One patient died prior to his 1 year follow up and 1 patient subsequently underwent liver transplantation. Mean length of stay was longer among cirrhotics (4.2 ± 4.4 vs 2.6 ± 1.7 days, p=0.039) but other safety end points and weight loss were not different (Table 1).
Conclusions: Foregut bariatric surgery has excellent safety and efficacy in patients with compensated cirrhosis.
Table 1: Patient Characteristics and Outcomes
| | Cases
(n=43)
| Controls
(n=129)
| p-value | | Age (Years, Mean ± SD) | 53.3 ± 11.0 | 53.2 ± 10.5 | 0.7 | | BMI (Kg/m2, Mean ± SD) | 45.8 ± 9.6 | 45.8 ± 8.8 | 1.0 | | Females (%) | 60.5 | 60.5 | 1.0 | Type of Surgery (%)
Roux-En-Y
Sleeve Gastrectomy
|
67
30
|
68
29.5
| 1.0 | | Platelet Count (mm3, Mean ± SD) | 176 ± 53 | 238 ± 49 | 0.001 | | FIB4 Score Preoperative (Mean ± SD) | 2.07 ± 1.61 | 1.16 ± 0.57 | 0.001 | | Length of Stay (Days, Mean ± SD) | 4.2 ± 4.4 | 2.6 ± 1.7 | 0.039 | | Intraoperative Complications (%) | 2.3 | 2.3 | 1.0 | | 30-Day Readmission (%) | 7 | 11 | 0.6 | 90 Day Postoperative Complications (%)
Infection
Bleed
DVT/PE
Anastomotic Stricture
Other
| 18.6
4.7
2.3
0
2.3
9.3
| 16.3
3.1
0
1.6
9.3
2.3
| 0.7 | | 30 Day Weight Loss (% from baseline, Mean ± SD) | 8.4 ± 7.4 | 8.4 ± 2.5 | 1.0 | | 90 Day Weight Loss (% from baseline, Mean ± SD) | 14.3 ± 7.4 | 15.5 ± 5.1 | 0.9 | | 180 Day Weight Loss (% from baseline, Mean ± SD) | 19.6 ± 9.4 | 23.2 ± 6.8 | 0.06 | | 1 Year Weight Loss (% from baseline, Mean ± SD) | 25.7 ± 11.3 | 28.4 ± 9.9 | 0.2 | | Death at 30 Days (%) | 0 | 0 | 1.0 | | Death at 90 Days (%) | 0 | 0 | 1.0 | | Death at 180 Days (%) | 0 | 0 | 1.0 | | Death at 1 Year (%) | 2.3 | 0 | 0.25 |
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