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Clinical Trial
. 2018 Dec;28(12):4022-4033.
doi: 10.1007/s11695-018-3466-7.

Laparoscopic Sleeve Gastrectomy Resolves NAFLD: Another Formal Indication for Bariatric Surgery?

Carlos Martin Esquivel  1   2 , Manuel Garcia  3 , Lucas Armando  4   3 , Guillermo Ortiz  4   3 , Fernando Martínez Lascano  4   3   5 , José María Foscarini  4   5
Affiliations
Clinical Trial

Laparoscopic Sleeve Gastrectomy Resolves NAFLD: Another Formal Indication for Bariatric Surgery?

Carlos Martin Esquivel et al. Obes Surg. 2018 Dec.

Abstract

Introduction: Obesity is strongly associated with non-alcoholic fatty liver disease (NAFLD); 66-99% of the obese population could suffer some grade of NAFLD. It can progress into cirrhosis, which is associated to hepatocellular carcinoma, and a liver transplant could be indicated. NAFLD represents the third cause of liver transplant, and it is expected to be the first by 2025. Sleeve gastrectomy (SG) is the most common bariatric procedure over the world. There is scant literature regarding NAFLD after SG, and there are no prospective studies published up to date.

Objective: To evaluate the evolution of NAFLD in patients with obesity after 1 year of SG.

Methods: From January 2009 to December 2013, intraoperative liver biopsy was performed in 63 obese patients who underwent SG. Forty-three patients were again biopsied 1 year after surgery. Demographics, body mass index, percentage of excess weight loss, liver function test, lipid panel, glucose panel, and histological changes were prospectively analyzed.

Results: One hundred percent of the patients reversed or reduced the stage of steatosis or steatohepatitis 12 months after surgery, obtaining a statistically significant difference for both steatosis and steatohepatitis. One patient presented complete cirrhosis regression in the pathology. Neither of the patients had worsened liver histology.

Conclusions: NAFLD could be dealt with laparoscopic sleeve gastrectomy, preventing its progression into cirrhosis. SG can be performed in patients with obesity and metabolic syndrome, with NAFLD showing satisfactory results 12 months after surgery. NAFLD should be a formal indication for bariatric surgery.

Keywords: Bariatric surgery; NAFLD; Sleeve gastrectomy.

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