Comparison of Liver Recovery After Sleeve Gastrectomy and Roux-en-Y-Gastric Bypass

Abstract

Background Nonalcoholic fatty liver disease (NAFLD) is a common condition in patients with obesity. Bariatric surgery has often been proposed as a viable treatment option, but the ideal surgical procedure remains unclear. Inconsistently, reports on postoperative deterioration of liver function put further doubt on which technique to apply. Aim of this study was to assess the impact of Roux-en-Y-gastric bypass (RYGB) and sleeve gastrectomy (SG) on the postoperative recovery of liver function. Methods A total of 175 patients with obesity that underwent bariatric surgery in our institution were included in this prospective cohort study. BMI, laboratory values, and liver function capacity (using LiMAx) were assessed preoperatively and at 6 and 12 months postoperatively. Generalized linear model (GLM) was performed to determine variables influencing liver function capacity after the operation. Results Prior to operations, 64% of patients presented with a diminished liver function capacity, as measured by LiMAx test. Liver function capacity significantly recovered after 12 months in the SG group (300 μg/kg/h preop vs. 367 μg/kg/h postop) but not in the RYGB group (306 μg/kg/h preop vs. 349 μg/kg/h). Preoperative factors impeding liver function recovery included type 2 diabetes mellitus (T2DM), weight, male sex, AST/thrombocyte ratio (APRI), and gamma-glutamyltransferase (GGT). Conclusion Bariatric surgery, especially sleeve gastrectomy, leads to an improvement of liver function. However, in some patients with T2DM, higher preoperative weight and male sex postoperative deterioration of liver function capacity may occur. Graphical abstract

Improvement of Type 2 Diabetes Mellitus and Attenuation of NAFLD Are Associated with the Success of Obesity Therapy

“…NFS was significantly reduced by LCD as well as by RYGB, which is in accordance with beneficial effects on NAFLD having been reported for bariatric surgery [ 19 , 29 ]. Appearing somewhat contradictory, mean BARD scores addressing liver fibrosis increased during 12 months of weight loss in LCD patients.…”

“…Therefore, it appears reasonable to assume that the pronounced reduction in body fat percentage in men might be causally linked with a stronger decrease in NAFLD-related fibrosis risk. On the other hand, a recent study from Schmitz et al suggested male sex as one of several factors impeding the recovery of liver function in bariatric surgery [ 19 ]. Thus, a rather complex sexual dimorphism regarding the therapeutic impact of diet and bariatric surgery both on obesity and liver fibrosis should definitely be considered and will have to be examined in detail by further studies.…”

“…Given the known causal relations of metabolic disorders [ 13 ], regulation and improvement of T2D and NAFLD under the terms of excessive weight loss in obese individuals represent a crucial issue for a better understanding of the interactions between distinct MetS comorbidities and for the development of therapeutic approaches applicable in order to improve obesity as well as glucose metabolism and liver integrity. Gastric sleeve and RYGB have been reported to significantly improve hepatic insulin sensitivity [ 18 ] and liver function in obesity-related NAFLD [ 19 ] and represent potential therapeutic strategies for NAFLD treatment [ 20 , 21 ]. In particular, a comparison of metabolic effects induced by bariatric surgery and diet as alternative approaches is of high interest [ 22 ].…”

Portomesenteric Vein Thrombosis after Bariatric Surgery: An Online Survey

“…However, in severe cases, it can potentially be lethal due to the risk of associated bowel ischemia (Figure 4) and potential late risk of chronic bilioportal cholangiopathy that can lead to small bowel resection and even liver transplantation [9]. Moreover, the occurrence of PMVT is among the factors that influence early postoperative liver function capacity of patients after bariatric surgery [10]. In our survey, the most common presentation was abdominal pain in over 96% of cases, followed by nausea in almost half of cases, and vomiting in 27%.…”

Clinical implications of hepatic structure and function evaluation based on vibration-controlled transient elastography and liver maximum function capacity test in patients with nonalcoholic fatty liver disease

“…In the NAFLD/NASH setting, LiMAx has so far been assessed in the subgroup of patients scheduled for bariatric surgery [16][17][18]: Hepatic function was lower in individuals with NASH compared to those without and in patients with increasing stages of hepatic fibrosis [16,17]. In patients with type 2 diabetes (T2D), the recovery of liver function after bariatric surgery was significantly impaired [18]. A pilot study assessing the relationship between LiMAx and elastography in a cohort with different chronic liver diseases observed a negative correlation between hepatic function and shear wave speed measured by two-dimensional time-harmonic elastography indicating that increased tissue stiffness is associated with a decreased metabolic capacity of the liver [19].…”