Published online Jul 28, 2018. doi: 10.3748/wjg.v24.i28.3112
Peer-review started: April 5, 2018
First decision: May 9, 2018
Revised: May 17, 2018
Accepted: June 25, 2018
Article in press: June 25, 2018
Published online: July 28, 2018
With the ever increasing global obesity pandemic, clinical burden from obesity related complications are anticipated in parallel. Bariatric surgery, a treatment approved for weight loss in morbidly obese patients, has reported to be associated with good outcomes, such as reversal of type two diabetes mellitus and reducing all-cause mortality on a long term basis. However, complications from bariatric surgery have similarly been reported. In particular, with the onslaught of non-alcoholic fatty liver disease (NAFLD) epidemic, in associated with obesity and metabolic syndrome, there is increasing prevalence of NAFLD related liver cirrhosis, which potentially connotes more risk of specific complications for surgery. Bariatric surgeons may encounter, either expectedly or unexpectedly, patients with non-alcoholic steatohepatitis (NASH) and NASH related cirrhosis more frequently. As such, the issues and considerations surrounding their medical care/surgery warrant careful deliberation to ensure the best outcomes. These considerations include severity of cirrhosis, liver synthetic function, portal hypertension and the impact of surgical factors. This review explores these considerations comprehensively and emphasizes the best approach to managing cirrhotic patients in the context of bariatric surgery.
Core tip: Bariatric surgery can be performed in patients with well compensated cirrhosis, typically of Child’s A status, with minimal complication risks from surgical or hepatic factors. Patients need to be carefully selected and optimised, while surgical technique and modality also play equally important roles. With the onslaught of the non-alcoholic fatty liver disease epidemic and anticipated increase in patients with non-alcoholic steatohepatitis cirrhosis, bariatric surgery may provide an elixir as part of the armamentarium of therapeutic options.