Obesity Surgery

, Volume 29, Issue 2, pp 585–592 | Cite as

Outcomes of Bariatric Surgery in Patients with Cirrhosis

  • Inka MiñambresEmail author
  • Miguel Angel Rubio
  • Ana de HollandaEmail author
  • Irene Breton
  • Nuria Vilarrasa
  • Silvia Pellitero
  • Marta Bueno
  • Albert Lecube
  • Clara Marcuello
  • Albert Goday
  • Maria D. Ballesteros
  • German Soriano
  • Assumpta Caixàs
Original Contributions



Information concerning the risk–benefit profile of bariatric surgery in subjects with liver cirrhosis is scarce. Our aim was to describe the long-term outcomes of bariatric surgery in a cohort of patients with liver cirrhosis submitted to bariatric surgery.


This was a multicenter, retrospective observational study performed by the Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN), with a review of patients with cirrhosis who had undergone bariatric surgery during the period from April 2004 to March 2017 in ten public reference hospitals in Spain.


Data on 41 patients with cirrhosis submitted to obesity surgery were collected (mean age 53.8 ± 7.9 years, 46.3% women, presurgical BMI 45 ± 8.3 kg/m2). All but one patient belonged to Child–Pugh class A, and sleeve gastrectomy was conducted in 68.3% of cases. Percentage of total weight loss (%TWL) was 26.33 ± 8.3% and 21.16 ± 15.32% at 1 and 5 years after surgery, respectively. This was accompanied by a significant reduction of type 2 diabetes, high blood pressure, and dyslipidemia and by an improvement of liver enzymes over time. Model for End-Stage Liver Disease (MELD) index increased from 7.2 ± 1.9 to 9.8 ± 4.6 after 5 years. Seven patients (17%) developed early postsurgical complications. No postsurgical mortality was observed. During follow-up, only five patients developed liver decompensation.


Bariatric surgery in selected patients with liver cirrhosis has metabolic benefits that could have a positive impact on liver prognosis.

Trial Registration Identifier: 10.1186/ISRCTN15009106


Obesity surgery Liver Cirrhosis 



We would like to thank The Obesity Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN) for participating and providing data for this study. The authors thank Martin Price for his valuable help with the English version of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Luyckx FH, Desaive C, Thiry A, et al. Liver abnormalities in severely obese subjects: effect of drastic weight loss after gastroplasty. Int J Obes Relat Metab Disord. 1998;22(3):222–6.CrossRefGoogle Scholar
  2. 2.
    Dietrich P, Hellerbrand C. Non-alcoholic fatty liver disease, obesity and the metabolic syndrome. Best Pract Res Clin Gastroenterol. 2014;28(4):637–53.CrossRefGoogle Scholar
  3. 3.
    Machado M, Marques-Vidal P, Cortez-Pinto H. Hepatic histology in obese patients undergoing bariatric surgery. J Hepatol. 2006;45(4):600–6.CrossRefGoogle Scholar
  4. 4.
    Berzigotti A, Garcia-Tsao G, Bosch J, et al. Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis. Hepatology. 2011;54(2):555–61.CrossRefGoogle Scholar
  5. 5.
    Kral JG, Thung SN, Biron S, et al. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery. 2004;135(1):48–58.CrossRefGoogle Scholar
  6. 6.
    Cazzo E, Gestic MA, Utrini MP, et al. Bariatric surgery in individuals with liver cirrhosis: a narrative review. Rev Assoc Med Bras (1992). 2017;63(2):190–4.CrossRefGoogle Scholar
  7. 7.
    Millwala F, Nguyen GC, Thuluvath PJ. Outcomes of patients with cirrhosis undergoing non-hepatic surgery: risk assessment and management. World J Gastroenterol. 2007;13(30):4056–63.CrossRefGoogle Scholar
  8. 8.
    Csikesz NG, Nguyen LN, Tseng JF, et al. Nationwide volume and mortality after elective surgery in cirrhotic patients. J Am Coll Surg. 2009;208(1):96–103.CrossRefGoogle Scholar
  9. 9.
    Rice HE, O'Keefe GE, Helton WS, et al. Morbid prognostic features in patients with chronic liver failure undergoing nonhepatic surgery. Arch Surg. 1997;132(8):880–4. discussion 4-5CrossRefGoogle Scholar
  10. 10.
    Ramos-Levi AM, Rubio Herrera MA. Metabolic surgery: quo vadis? Endocrinol Nutr. 2014;61(1):35–46.CrossRefGoogle Scholar
  11. 11.
    Buchwald H, Estok R, Fahrbach K, et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621–32. discussion 32-5CrossRefGoogle Scholar
  12. 12.
    Mosko JD, Nguyen GC. Increased perioperative mortality following bariatric surgery among patients with cirrhosis. Clin Gastroenterol Hepatol. 2011;9(10):897–901.CrossRefGoogle Scholar
  13. 13.
    Jan A, Narwaria M, Mahawar KK. A systematic review of bariatric surgery in patients with liver cirrhosis. Obes Surg. 2015;25(8):1518–26.CrossRefGoogle Scholar
  14. 14.
    Sjostrom L. Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.CrossRefGoogle Scholar
  15. 15.
    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.CrossRefGoogle Scholar
  16. 16.
    Lecube A, Monereo S, Rubio MA, et al. Prevention, diagnosis, and treatment of obesity. 2016 position statement of the Spanish Society for the Study of Obesity. Endocrinol Diabetes Nutr. 2017;64(Suppl 1):15–22.CrossRefGoogle Scholar
  17. 17.
    Shimizu H, Phuong V, Maia M, et al. Bariatric surgery in patients with liver cirrhosis. Surg Obes Relat Dis. 2013;9(1):1–6.CrossRefGoogle Scholar
  18. 18.
    Pestana L, Swain J, Dierkhising R, et al. Bariatric surgery in patients with cirrhosis with and without portal hypertension: a single-center experience. Mayo Clin Proc. 2015;90(2):209–15.CrossRefGoogle Scholar
  19. 19.
    Dallal RM, Mattar SG, Lord JL, et al. Results of laparoscopic gastric bypass in patients with cirrhosis. Obes Surg. 2004;14(1):47–53.CrossRefGoogle Scholar
  20. 20.
    Woodford RM, Burton PR, O'Brien PE, et al. Laparoscopic adjustable gastric banding in patients with unexpected cirrhosis: safety and outcomes. Obes Surg. 2015;25(10):1858–62.CrossRefGoogle Scholar
  21. 21.
    Ghio B, Jimenez A, Corcelles R, et al. Midterm effects of bariatric surgery in patients with insulin-treated type 2 diabetes. Surg Obes Relat Dis. 2017;13(12):2004–9.CrossRefGoogle Scholar
  22. 22.
    Lecube A, de Hollanda A, Calanas A, et al. Trends in bariatric surgery in Spain in the twenty-first century: baseline results and 1-month follow up of the RICIBA, a national registry. Obes Surg. 2016;26(8):1836–42.CrossRefGoogle Scholar
  23. 23.
    Ascha MS, Hanouneh IA, Lopez R, et al. The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis. Hepatology. 2010;51(6):1972–8.CrossRefGoogle Scholar
  24. 24.
    Bromberger B, Porrett P, Choudhury R, et al. Weight loss interventions for morbidly obese patients with compensated cirrhosis: a Markov decision analysis model. J Gastrointest Surg. 2014;18(2):321–7.CrossRefGoogle Scholar
  25. 25.
    Brolin RE, Bradley LJ, Taliwal RV. Unsuspected cirrhosis discovered during elective obesity operations. Arch Surg. 1998;133(1):84–8.CrossRefGoogle Scholar
  26. 26.
    Baltasar A. Liver cirrhosis and bariatric operations. Surg Obes Relat Dis. 2006;2(5):580. author reply −1CrossRefGoogle Scholar
  27. 27.
    Geerts A, Darius T, Chapelle T, et al. The multicenter Belgian survey on liver transplantation for hepatocellular failure after bariatric surgery. Transplant Proc. 2010;42(10):4395–8.CrossRefGoogle Scholar
  28. 28.
    Takata MC, Campos GM, Ciovica R, et al. Laparoscopic bariatric surgery improves candidacy in morbidly obese patients awaiting transplantation. Surg Obes Relat Dis. 2008;4(2):159–64. discussion 64-5CrossRefGoogle Scholar
  29. 29.
    Lin MY, Tavakol MM, Sarin A, et al. Laparoscopic sleeve gastrectomy is safe and efficacious for pretransplant candidates. Surg Obes Relat Dis. 2013;9(5):653–8.CrossRefGoogle Scholar
  30. 30.
    Aller R, Fernandez-Rodriguez C, Lo Iacono O, et al. Consensus document. Management of non-alcoholic fatty liver disease (NAFLD). Clinical practice guideline. Gastroenterol Hepatol. 2018;41(5):328–49.CrossRefGoogle Scholar
  31. 31.
    Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328–57.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Inka Miñambres
    • 1
    • 2
    Email author
  • Miguel Angel Rubio
    • 3
  • Ana de Hollanda
    • 4
    Email author
  • Irene Breton
    • 5
  • Nuria Vilarrasa
    • 6
    • 7
  • Silvia Pellitero
    • 7
    • 8
  • Marta Bueno
    • 9
  • Albert Lecube
    • 7
    • 9
  • Clara Marcuello
    • 3
  • Albert Goday
    • 2
    • 10
    • 11
  • Maria D. Ballesteros
    • 12
  • German Soriano
    • 2
    • 13
    • 14
  • Assumpta Caixàs
    • 15
  1. 1.Endocrinology and Nutrition DepartmentHospital de La Santa Creu i Sant PauBarcelonaSpain
  2. 2.Medicine DepartmentUniversitat Autònoma de BarcelonaBarcelonaSpain
  3. 3.Endocrinology and Nutrition Department. Hospital Clínico San Carlos. IDISSC. Facultad de MedicinaUniversidad ComplutenseMadridSpain
  4. 4.Obesity UnitHospital Clínic UniversitariBarcelonaSpain
  5. 5.Endocrinology and Nutrition DepartmentHospital General Universitario Gregorio MarañónMadridSpain
  6. 6.Department of Endocrinology and NutritionBellvitge University Hospital-IDIBELLBarcelonaSpain
  7. 7.CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)Instituto de Salud Carlos IIIMadridSpain
  8. 8.Department of Endocrinology and NutritionGermans Trias i Pujol University Hospital-IGTPBarcelonaSpain
  9. 9.Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova. Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleidaUniversity of LleidaLleidaSpain
  10. 10.Endocrinology and Nutrition DepartmentHospital del MarBarcelonaSpain
  11. 11.Centro de Investigaciones Biomédicas en Red de Obesidad y Nutrición, CIBERobnMadridSpain
  12. 12.Endocrinology and Nutrition DepartmentComplejo Asistencial Universitario de LeónLeonSpain
  13. 13.Department of GastroenterologyHospital de la Santa Creu i Sant PauBarcelonaSpain
  14. 14.CIBERehd, Instituto de Salud Carlos IIIMadridSpain
  15. 15.Department of Endocrinology and NutritionParc Taulí University Hospital, UABSabadellSpain

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