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Manzano-Nunez R, Rivera-Esteban J, Comas M, Angel M, Flores V, Bañares J, Ciudin A, Vilallonga R, Pericas JM. Outcomes of Patients with Severe Obesity and Cirrhosis with Portal Hypertension Undergoing Bariatric Surgery: a Systematic Review. Obes Surg 2023; 33:224-233. [PMID: 36422758 DOI: 10.1007/s11695-022-06362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/02/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Thus far, little attention has been paid to bariatric surgery (BS) in patients with severe obesity (SO) and cirrhosis with portal hypertension (PH). To address this knowledge gap, we systematically reviewed the available literature and evidence about BS in patients with SO and cirrhosis with PH. We inform on the perioperative and long-term outcomes of this intervention. MATERIALS AND METHODS Articles were identified in MEDLINE, SCOPUS, LILACS, and SCIELO, and included if they analyzed SO patients with clinically significant PH and reported the characteristics and outcomes of BS. RESULTS Six articles, including 32 patients, were included. The most frequent type of BS was sleeve gastrectomy performed in 27 patients. Perioperative transfusions were often not required, with only one case report describing the use of 1 unit of packed red blood cells post-operatively. Neither intraoperative nor post-op deaths were reported. All patients reported significant weight loss with improvements in comorbidities during the follow-up periods. Overall, 27 out of 29 patients had T2DM resolution, and 13 out of 23 had arterial hypertension resolution. One study reported improvements in the parameters of fibroscan. CONCLUSION This systematic review described the outcomes of BS among patients with SO with cirrhosis and PH. Performing this kind of surgery among these patients appears safe and associated with acceptable perioperative and long-term outcomes. However, further studies are required to provide evidence-based, strong recommendations.
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Affiliation(s)
- Ramiro Manzano-Nunez
- Liver Unit, Vall d'Hebron University Hospital, Desk 071, Ground Floor, Main Building, Pg de La Vall d'Hebron, 119-129, 08035, Barcelona, PC, Spain.,Vall d'Hebron Institute for Research, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesus Rivera-Esteban
- Liver Unit, Vall d'Hebron University Hospital, Desk 071, Ground Floor, Main Building, Pg de La Vall d'Hebron, 119-129, 08035, Barcelona, PC, Spain.,Vall d'Hebron Institute for Research, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Comas
- Vall d'Hebron Institute for Research, Barcelona, Spain.,Endocrinology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mariana Angel
- Facultad de Salud, Escuela de Medicina, Universidad del Valle (Univalle), Cali, Colombia
| | - Vanesa Flores
- Vall d'Hebron Institute for Research, Barcelona, Spain.,Endocrinology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Juan Bañares
- Liver Unit, Vall d'Hebron University Hospital, Desk 071, Ground Floor, Main Building, Pg de La Vall d'Hebron, 119-129, 08035, Barcelona, PC, Spain
| | - Andreea Ciudin
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Endocrinology Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Centros de Investigación Biomédica en Red, Diabetes and Metabolism (CIBERdem), Madrid, Spain
| | - Ramon Vilallonga
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Digestive Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Juan M Pericas
- Liver Unit, Vall d'Hebron University Hospital, Desk 071, Ground Floor, Main Building, Pg de La Vall d'Hebron, 119-129, 08035, Barcelona, PC, Spain. .,Vall d'Hebron Institute for Research, Barcelona, Spain. .,Digestive Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain.
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