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- W2734425504 abstract "Objective: With non-alcoholic steatohepatitis (NASH) projected to become the leading indication for liver transplantation in the next decade, we pursued strategies to proactively treat obese cirrhotic patients awaiting transplant. Methods: Data was collected prospectively on 9 patients with liver disease who underwent laparoscopic sleeve gastrectomy (LSG) by a single surgeon. A multidisciplinary team implemented criteria for patient selection: (1) Model for End-stage Liver Disease (MELD) score <15, (2) no evidence of portal hypertension (3) no ascites (4) platelet count >50,000 U/μL. Patient demographics, comorbidities, body mass index (BMI), MELD scores, and laboratory values were analyzed retrospectively. Results: Etiologies of liver disease were NASH (n=7), primary sclerosing cholangitis (n=1), and autoimmune hepatitis (n=1). Median age was 46 years (range 43–59 years). Median pre-operative MELD score was 7 (range 6–14). Mean pre-operative BMI was 44.4±7.3 kg/m2. Follow-up after LSG was 141±126 days with post-operative BMI average of 36.9±7.8 kg/m2. Mean percentage of excess weight loss was 35.3±23.6%. There were no complications or acute liver decompensation during follow-up. No clinically significant differences were seen between pre- and post-operative liver function tests. Of the three patients who required insulin, two were able to discontinue insulin, and the third demonstrated a 93% reduction (270 U/day to 20 U/day). Conclusion: By adhering to strict pre-operative guidelines, laparoscopic sleeve gastrectomy is a safe and effective means of weight loss in cirrhotic patients awaiting transplantation. Application of these guidelines will lead to improvement of obesity-related conditions in the cirrhotic population and potentially eliminate their need for liver transplantation.Tabled 1AgePre-op MELDPre-op BMIPost-op BMI%EWLLength of follow-up (days)Length of stay (days)Pre-op anti-hypertensive medicationsPost-op anti-hypertension medicationsPre-op insulinPost-op insulinPatient 145842.7935.0431.1313710000Patient 244747.5836.3044.99179140900Patient 349743.7537.8534.7910211000Patient 444733.6031.4921.164121000Patient 543958.5751.616.683410000Patient 6591443.9125.1189.805311100Patient 756738.9634.2341.5731211227020Patient 854639.6834.7428.053952100Patient 946751.0046.0019.373771101400MELD=Model for End-Stage Liver Disease Score; BMI=body mass index; %EWL=percent excess weight loss. Open table in a new tab MELD=Model for End-Stage Liver Disease Score; BMI=body mass index; %EWL=percent excess weight loss." @default.
- W2734425504 created "2017-07-21" @default.
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- W2734425504 date "2017-04-01" @default.
- W2734425504 modified "2023-09-26" @default.
- W2734425504 title "Novel guidelines for safe and effective sleeve gastrectomy in cirrhotic patients awaiting transplant" @default.
- W2734425504 doi "https://doi.org/10.1016/j.hpb.2017.02.185" @default.
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