Mahendra Narwaria
Asian Bariatrics Pvt.Ltd., India
Title: Bariatric surgery in patients with liver cirrhosis
Biography
Biography: Mahendra Narwaria
Abstract
Morbid obesity is almost universally associated with non alcoholic fatty liver disease (NAFLD) and approximately half of the patients undergoing obesity surgery suffer with non alcoholic steatohepatitis (NASH). It is becoming a common cause of liver cirrhosis. Bariatric surgery can benefit obese patients with cirrhosis through weight loss and alteration of metabolic milieu as well as increase the eligibility of candidate for liver transplant. Accurate risk versus benefit analysis of each bariatric procedure in cirrhotic patients can be extremely challenging and currently there is lack of consensus among surgeons regarding safety of bariatric surgery in such patients with liver cirrhosis and the best bariatric procedure for them. The review shows an acceptably higher overall risk of complications and peri-operative mortality with bariatric surgery in cirrhotic patients. In this review, LSG and AGB appear to be safest bariatric procedure in obese patients with cirrhosis undergoing bariatric surgery. However, larger studies are needed on long term safety and efficacy of these procedures on cirrhotic patients to make clear recommendations. Surgeons must discuss the possibility of an unexpected intra-operative finding of cirrhosis preoperatively with all bariatric surgery patients and agree on a course of action to empower both patient and the surgeon.