Obesity and liver transplantation

Table 1 Summary of advantages and disadvantages of different categories of bariatric surgeries in the context of liver transplantation

Procedure	Category	Description	(%) Excess weight loss	Pros	Cons
Adjustable gastric banding	Restrictive	Silicone band placed at the upper portion of the stomach	40-50	Minimally invasive, adjustable, reversible, removable, access to biliary tree is maintained	Foreign body placement, relatively longer duration for weight-loss, long-term potential complications of band erosion, pouchitis, pouch enlargement, gastric prolapse, slippage and flipped port, tubing breakage, malfunction of the device, port site infections
Sleeve gastrectomy	Restrictive	Removal of greater part of greater curvature of the stomach	50-60	Maintains gastric function with direct access to biliary tree, has better tolerance of oral/medications intake and absorption	Long staple-line on the stomach with a potential for bleeding and gastroinstestinal leak
Roux-en-Y gastric bypass	Mostly restrictive	Creation of gastric pouch and rerouting of intestine	70	Combined restrictive and malabsorptive procedure, resolution of comorbidities is relatively quicker with higher proportion of weight-loss	Relatively higher significant perioperative complications, intolerance to oral consumption, and absorption of medications, loss of direct access to biliary tree and remnant stomach, can lead to excessive weight-loss, higher likelihood of malnourishment
Duodenal switch	Malabsorptive	Subtotal gastrectomy with a very short common channel	80

Percentage of excess weight loss = [(preoperative weight - weight at follow-up)/(preoperative weight - ideal body weight)] × 100.