• Raj Vuppalanchi, Marshall E McCabe, Sweta R Tandra, Siva P Parcha, Adil Ghafoor, Leslie Schuh, Margaret M Inman, Don J Selzer, Dimitrios Stefanidis, and Naga Chalasani.
• Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
• Ann. Surg. 2022 Jan 1; 275 (1): e174-e180.

ObjectiveTo assess the safety and efficacy of bariatric surgery in patients with cirrhosis.Summary Background DataBariatric surgery may be a viable option for patients with cirrhosis and extreme obesity. However, the risk of liver decompensation after surgery is not thoroughly investigated.MethodsWe conducted a case-controlled study with 106 obese patients with cirrhosis (cases) and 317 age, sex, body mass index-, and type of surgery-matched obese patients without cirrhosis (controls) who underwent bariatric surgery.ResultsPatients with cirrhosis were predominantly Child-Pugh class A (97%) with the diagnosis established prior to surgery in only 46%. In the cirrhosis group, there was no death in the first 30 days compared with 1 patient in the control group. At 90 days there was 1 death in the cirrhosis group but no additional deaths in the control group. In total, 12 months after the surgery, there were 3 deaths in the cirrhosis group and 1 in the control group (2.8% vs 0.6%, P = 0.056). The surgery-related length of stay was significantly longer in patients with cirrhosis (3.7 ± 4.0 vs 2.6 ± 2.4 d, P = 0.001), but the 30-day readmission rate was lower (7.5% vs 11.9%, P = 0.001). The percent of total weight loss at 30 and 90-days was not significantly different between the groups and remained that way even at 1 year (29.1 ± 10.9 vs 31.2 ± 9.4%, P = 0.096).ConclusionsBariatric surgery in obese cirrhotic patients is not associated with excessive mortality compared with noncirrhotic obese patients.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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