Laparoscopic Sleeve Gastrectomy for Obesity After Combined Liver-intestinal Transplantation: A Case Report

Abstract

A fter intestinal transplantation (ITx), up to 24% of patients with premorbid obesity will have persistence or relapse of obesity. 1 This is important because obesity is an independent risk factor for graft loss, delayed graft function, and reduced patient survival. 2 Bariatric surgery is the most effective and durable treatment for morbid obesity. Beneficial effects of bariatric surgery are in part due to altered gastrointestinal physiology and gut-brain-endocrine signaling pathways, which regulate hunger, satiety, and nutrient metabolism. 3 In regard to the transplanted intestine, it is unclear whether these pathways can still be therapeutically used because there is intestinal lymphatic disruption and enteric denervation. 4 When one of