Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis

Kral, John G.; Thung, Swan N.; Biron, Simon; Hould, Frédéric‐Simon; Lebel, Stéfane; Marceau, Simon; Simard, Serge; Marceau, Picard

doi:10.1016/j.surg.2003.10.003

Cited by 301 publications

(219 citation statements)

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“…[115][116][117][118][119][120][121][122][123][124][125][126][127][128][129][130][131][132][133] A schematic representation of the search in the online databases and the identification, exclusion and selection of the articles is presented in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Nonalcoholic fatty liver disease and bariatric surgery: a comprehensive review

2017

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CONTEXT AND OBJECTIVE: Nonalcoholic fatty liver disease (NAFLD) has been increasingly diagnosed worldwide and is now recognized as a source of public health concern. It comprises a wide spectrum of histological features that range from simple steatosis to severe forms of fibrosis, steatohepatitis and even cirrhosis. The impact of bariatric surgery on the course of NAFLD in individuals with obesity has been extensively studied. DESIGN AND SETTING: Narrative review; public university hospital. METHODS: A comprehensive review was conducted based on an online search on the electronic databases MEDLINE and LILACS using the MeSH terms "fatty liver" and "bariatric surgery". RESULTS:The exact mechanisms that lead to improvement in NAFLD following bariatric surgery are not completely understood. Since Roux-en-Y gastric bypass (RYGB) is the bariatric surgical procedure most performed worldwide, it is also the one from which the effects on NAFLD have been most studied, although there is also consistent evidence regarding the effects from gastric banding, sleeve gastrectomy and biliopancreatic diversions. CONCLUSION: According to the currently available evidence, bariatric surgery leads to significant improvement in NAFLD. Further research, especially by means of randomized controlled trials enrolling larger cohorts of individuals, is needed to determine the optimal procedure for this group of subjects. RESUMO CONTEXTO E OBJETIVO:A doença hepática gordurosa não alcoólica (DHGNA) tem sido diagnosticada com maior frequência em todo o mundo na atualidade, sendo agora reconhecida como motivo de preocupação em saúde pública. Abrange um amplo espectro de alterações histológicas que variam desde a simples esteatose até formas graves de fibrose, esteato-hepatite e até cirrose. O impacto da cirurgia bariátrica sobre o curso da DHGNA em indivíduos com obesidade tem sido profundamente estudado. TIPO DE ESTUDO E LOCAL: Revisão narrativa; hospital universitário público. MÉTODOS: Uma revisão abrangente da literatura foi conduzida baseada na pesquisa on-line nas bases de dados eletrônicas MEDLINE e LILACS por meio dos termos MeSH "fígado gorduroso" e "cirurgia bariátrica". RESULTADOS: Os mecanismos exatos que levam à melhora da DHGNA após a cirurgia bariátrica não são completamente conhecidos. Como o bypass gástrico em Y de Roux é a cirurgia bariátrica mais realizada em todo o mundo, é também o procedimento cujos efeitos sobre DHGNA foram mais estudados, embora haja também evidências consistentes sobre os efeitos de banda gástrica, gastrectomia vertical e derivações biliopancreáticas. CONCLUSÃO: De acordo com as evidências atualmente disponíveis, a cirurgia bariátrica leva à melhora significativa da DHGNA. Mais estudos, especialmente por meio de ensaios clínicos randomizados e controlados, recrutando coortes maiores de indivíduos, são necessários para determinar o melhor procedimento para esse grupo de pacientes.

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Section: Resultsmentioning

confidence: 99%

Nonalcoholic fatty liver disease and bariatric surgery: a comprehensive review

2017

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“…Paralleling the rise in the incidence of obesity and diabetes worldwide, NAFLD is being increasingly recognized as one of the major causes of chronic liver disease (Flegal et al 1998;Salgado et al 2006). Steatohepatitis occurs in 24 to 95% of these patients, whereas fibrosis is implicated in 6 to 74% of the cases, and cirrhosis in 0 to 24% (Kral et al 2004;Salgado et al 2006). Doppler sonography is used as a major diag-not blinded when obtaining and grading portal venous waveforms.…”

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confidence: 99%

Portal Vein Hemodynamics in Patients with Non-Alcoholic Fatty Liver Disease

Erdoğmuş

Tamer

Büyükkaya

et al. 2008

Tohoku J. Exp. Med.

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Paralleling the rise in the incidence of obesity and diabetes worldwide, nonalcoholic fatty liver disease (NAFLD) is being increasingly recognized as one of the major causes of chronic liver disease. Doppler sonography is used as a diagnostic method in the non-invasive assessment of the hemodynamics of hepatic vascular flow in liver diseases. We investigated the effects of fatty infiltration in the liver on the Doppler flow hemodynamics of the portal vein. Doppler sonography of the liver and portal vein was performed in 60 subjects with NAFLD and 20 healthy volunteers (control). The patients were grouped into mild (grade 1), moderate (grade 2), and severe (grade 3) according to sonographic appearance of hepatosteatosis (n = 20 for each group). The vein pulsatility index (VPI), mean flow velocity (MFV), peak maximum velocity (V max ), and peak minimum velocity (V min ) of the portal vein were significantly lower in patients with NAFLD than those of the controls ( p < 0.001). The VPI was 0.20 in the patients and 0.31 in the control. The MFV was 12.3 cm/sec in the patients and 16.5 cm/sec in the control group. The portal vein flow was found to be decreased as the grade of fatty infiltration increased for VPI (r = -0.946, p < 0.001), MFV (r = -0.951, p < 0.001). The alteration in Doppler waveform pattern of portal vein with fatty liver population suggests reduced vascular compliance in the liver. doppler sonography; nonalcoholic fatty liver; portal vein pulsatility; hepatosteatosis; liver. Tohoku J. Exp. Med., 2008, 215 (1), 89-93.

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“…Other improvement shown was that ALT values could also significantly improve after the operation. Obesity associated with non-alcoholic fatty liver disease can also be resolved after bariatric surgery [11]. Some of the advantages include preservation of endoscopic access to the upper gastrointestinal tract, the lack of an intestinal anastomosis thus excluding the risk of internal herniation, normal intestinal absorption and prevention of dumping syndrome due to pylorus preservation [7].…”

Section: Discussionmentioning

confidence: 99%

A Sleeve Gastrectomy Complicated by Mesenteric Vein Thrombosis, Abdominal Compartment Syndrome and Pulmonary Emboli: Case Report

Leung¹,

Sorensen²

2015

Int J Biomed

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Background: Obesity is a growing problem all over the world, including the United States. Single-incision laparoscopic sleeve gastrectomy is a surgery performed for patients who want to lose weight. The number of deaths resulting from thromboembolic complications from bariatric surgeries continues to be of major concern.Case Description: A 38-year-old female was admitted for single incision sleeve gastrectomy and was discharged home three days later. Subsequently she began to have abdominal pain, nausea and vomiting. A CT scan revealed superior mesenteric vein thrombosis with small bowel ischemia, splenic infarction and main and right portal vein branch thrombosis. An exploratory laparotomy demonstrated necrotic bowel due to abdominal compartment syndrome, and an area of small bowel was resected due to internal hernia. Surgical management of the patient during her second hospital stay included a decompressive laparotomy, internal hernia reduction, a small bowel resection.Discussion: Superior mesenteric vein thrombosis can be a life-threatening complication and present with non-specific presentations; thus, it is imperative that it is identified and managed promptly as these cases carry significant morbidity and mortality. Obese patients who undergo bariatric surgery frequently have other co-morbidities; many of which can complicate a case further. Mesenteric vein thrombosis is normally treated with unfractionated or low-molecular-weight heparin. (Int J Bopmed. 2015;5(3):162-166.)

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Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis

Cited by 301 publications

References 63 publications

Nonalcoholic fatty liver disease and bariatric surgery: a comprehensive review

Nonalcoholic fatty liver disease and bariatric surgery: a comprehensive review

Portal Vein Hemodynamics in Patients with Non-Alcoholic Fatty Liver Disease

A Sleeve Gastrectomy Complicated by Mesenteric Vein Thrombosis, Abdominal Compartment Syndrome and Pulmonary Emboli: Case Report

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