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. 2021 Jul;31(7):3218-3226.
doi: 10.1007/s11695-021-05390-1. Epub 2021 Apr 4.

Comparison of Liver Recovery After Sleeve Gastrectomy and Roux-en-Y-Gastric Bypass

Sophia M-T Schmitz  1 , Andreas Kroh  2 , Alexander Koch  3 , Jonathan F Brozat  3 , Christine Stier  4 , Ulf P Neumann  2   5 , Tom F Ulmer  2   5 , Patrick H Alizai  2
Affiliations

Comparison of Liver Recovery After Sleeve Gastrectomy and Roux-en-Y-Gastric Bypass

Sophia M-T Schmitz et al. Obes Surg. 2021 Jul.

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) is a common condition in patients with obesity. Bariatric surgery has often been proposed as a viable treatment option, but the ideal surgical procedure remains unclear. Inconsistently, reports on postoperative deterioration of liver function put further doubt on which technique to apply. Aim of this study was to assess the impact of Roux-en-Y-gastric bypass (RYGB) and sleeve gastrectomy (SG) on the postoperative recovery of liver function.

Methods: A total of 175 patients with obesity that underwent bariatric surgery in our institution were included in this prospective cohort study. BMI, laboratory values, and liver function capacity (using LiMAx) were assessed preoperatively and at 6 and 12 months postoperatively. Generalized linear model (GLM) was performed to determine variables influencing liver function capacity after the operation.

Results: Prior to operations, 64% of patients presented with a diminished liver function capacity, as measured by LiMAx test. Liver function capacity significantly recovered after 12 months in the SG group (300 μg/kg/h preop vs. 367 μg/kg/h postop) but not in the RYGB group (306 μg/kg/h preop vs. 349 μg/kg/h). Preoperative factors impeding liver function recovery included type 2 diabetes mellitus (T2DM), weight, male sex, AST/thrombocyte ratio (APRI), and gamma-glutamyltransferase (GGT).

Conclusion: Bariatric surgery, especially sleeve gastrectomy, leads to an improvement of liver function. However, in some patients with T2DM, higher preoperative weight and male sex postoperative deterioration of liver function capacity may occur.

Keywords: Bariatric surgery; LiMAx; Liver function; NAFLD; Roux-en-Y-gastric bypass; Sleeve gastrectomy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Liver function capacity (LiMAx) in patients prior to surgery and after 6 and 12 months. Abbreviations: SG, sleeve gastrectomy; RYGB, Roux-en-Y-gastric bypass; * statistically significant using one-way ANOVA, p = 0.021
Fig. 2
Fig. 2
APRI in patients prior to surgery and after 6 and 12 months. Abbreviations: SG, sleeve gastrectomy; RYGB, Roux-en-Y-gastric bypass; ** statistically significant using one-way ANOVA, p = 0.007
See this image and copyright information in PMC

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