CC BY-NC-ND 4.0 · Semin Liver Dis 2021; 41(04): 448-460
DOI: 10.1055/s-0041-1731705
Review Article

Risks and Rewards of Bariatric Surgery in Advanced Chronic Liver Diseases

Yuly P. Mendoza*
1  Department of Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
2  Hepatology, Department of Biomedical Research, University of Bern, Switzerland
3  Graduate School for Health Sciences (GHS), University of Bern, Switzerland
,
Chiara Becchetti*
1  Department of Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
2  Hepatology, Department of Biomedical Research, University of Bern, Switzerland
,
Kymberly D. Watt#
4  Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
,
Annalisa Berzigotti#
1  Department of Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
2  Hepatology, Department of Biomedical Research, University of Bern, Switzerland
› Author Affiliations
Funding Y.P.M. and C.B. received financial support from the Stiftung für Leberkrankheiten Bern.

Abstract

The burden of obesity and metabolic syndrome has determined a sharp increase in bariatric surgery (BS) procedures, which lead to marked weight loss, improved metabolic syndrome, reduced cardiovascular risk, and even improvement in nonalcoholic steatohepatitis (NASH). Despite these promising results, BS in patients with chronic liver disease can rarely lead to worsening of liver function, progression to cirrhosis and its complications, and even liver transplantation. On the other hand, since obesity in patients with cirrhosis is a major cofactor for progression to a decompensated stage of the disease and a risk factor for hepatocellular carcinoma, BS has been used to achieve weight loss in this population. In this review, we critically analyze the existing data on outcomes of BS in patients with cirrhosis and the possible mechanisms leading to fibrosis progression and worsening liver function in patients undergoing BS. Finally, we propose a set of measures that could be taken to improve the multidisciplinary management of liver disease in patients undergoing BS, including early recognition of malnutrition and alcohol misuse.

* Yuly P. Mendoza and Chiara Becchetti equally contributed and share the first authorship.


# Kymberly D. Watt and Annalisa Berzigotti equally contributed and share the senior authorship.


Authors' Contributions

Y.P.M. and C.B. contributed towards conception, literature review, and drafting the manuscript; K.D.W. contributed towards critical revision of the manuscript for important intellectual content and editing the manuscript; A.B. contributed towards conception, critical revision of the manuscript for important intellectual content, drafting, and editing the manuscript. All the authors approved the final version of the manuscript.


Supplementary Material



Publication History

Publication Date:
09 July 2021 (online)

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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