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Obesity Surgery

, Volume 29, Issue 4, pp 1436–1438 | Cite as

Laparoscopic Sleeve Gastrectomy After Orthotopic Liver Transplantation, Video Reported

  • Georges Bou NassifEmail author
  • Chady Salloum
  • Luca Paolino
  • Daniel Azoulay
  • Andrea Lazzati
Video Submission
  • 98 Downloads

Abstract

Introduction

The immunosuppressive therapy for life after liver transplantation (LT) is considered as a risk factor for obesity. Seven percent of the transplanted patients develop severe or morbid obesity. The obesity induces non-alcoholic steatohepatitis (NASH), which is a major risk factor for liver cirrhosis and hepatocellular carcinoma, without forgetting the cardiovascular risk and the devastating impact of obesity on quality of life of the transplanted patients. Consequently, obesity exposes these patients to future transplant loss. Bariatric surgery has been proposed for transplant patients to reduce the obesity-related comorbidities and to improve survival. We report in this video the surgical technique of laparoscopic sleeve gastrectomy (LSG) after LT.

Methods

We have performed between 2008 and 2017 the sleeve gastrectomy (SG) after LT in nine patients. Six procedures (66%) were performed totally by laparoscopy and three by upfront laparotomy. All the patients had a standard preoperative evaluation for obesity. All the procedures were assisted by a hepatic surgeon. Postoperatively patients were transferred to the liver ICU for 24 h then to the liver unit ward.

Result

The median BMI was 41.9 kg/m2 (range 38–46.1 kg/m2). Median operative time was 120 min (range, 90–240 min). No intra-operative complications occurred. The median length of hospital stay was 7 days (range, 4–81 days). The postoperative course of the majority of the patients was uneventful except for one patient who develops a staple line leak.

Conclusion

LSG after LT is technically feasible. Larger series are needed to improve the safety of the procedure in this high-risk population.

Keywords

Steatohepatitis Bariatric surgery Sleeve gastrectomy Liver transplantation 

Notes

Compliance with Ethical Standards

Ethical Approval

The procedure was performed in accordance with the ethical standards of the institutional and the national research committee.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Informed Consent

Informed consent was obtained from the individual participant included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General SurgeryCenter Hospitalier Intercommunal de CréteilCréteilFrance
  2. 2.Service de Chirurgie Digestive, Hépato-BiliaireHôpital Henri-Mondor - AP-HPCréteilFrance

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