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Safety and Efficacy of Bariatric Surgery in Patients with Cirrhosis 

Safety and Efficacy of Bariatric Surgery in Patients with Cirrhosis
Chapter:
Safety and Efficacy of Bariatric Surgery in Patients with Cirrhosis
Author(s):

Hideharu Shimizu

, Tomasz G. Rogula

, and Philip R. Schauer

DOI:
10.1093/med/9780190608347.003.0021
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date: 09 December 2021

Perioperative risks for morbidly obese patients with cirrhosis are significant, and surgeons should consider these risks carefully in deciding on the type of bariatric procedure to be performed. The benefits of bariatric surgery for cirrhotic patients include substantial weight loss, improvements in metabolic diseases, and potential regression of fibrosis, which can also increase their eligibility and candidacy for liver transplantation. There is currently a lack of strong evidence, but the restrictive bariatric procedures are the safest options for carefully selected patients with cirrhosis. Sleeve gastrectomy is likely the best bariatric procedure for obtaining good outcomes without a prohibitive complication rate or mortality for patients with compensated, Child-Pugh class A cirrhosis without portal hypertension. Roux-en-Y gastric bypass is also appropriate for patients who are not suitable for sleeve gastrectomy. Surgeons should be prepared in case they see bariatric patients with cirrhosis diagnosed preoperatively or intraoperatively.

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