• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • 2022 NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • SAGES 2021 Annual Meeting
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2021
      • SAGES 2020
      • SAGES 2019
      • SAGES 2018
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • SAGES Logo Products
    • “Unofficial” Logo Products
  • Log In

Intraoperative finding of liver cirrhosis in bariatric surgery, the role of sleeve gastrectomy: A report of two consecutive cases

Miguel A Zapata Martinez, MD, Julio C Gallardo Baez, MD, Ulises Caballero-de la Pena, MD, Marco A Juarez-Parra, MD, David J Orozco-Agüet, MD, Jeronimo Monterrubio-Rodriguez, MD. Hospital Christus Muguerza Sur – Universidad de Monterrey

Introduction:

Obesity is a reported risk factor for non-alcoholic steatohepatitis (NASH), which is a common cause of cirrhosis. The estimated prevalence of nonalcoholic fatty liver disease (NAFLD) ranges from 84%-96% and for NASH 25%-55%. Up to 25% of patients with NASH will progress to liver cirrhosis. Cirrhosis is recognized incidentally in 1.4% of patients undergoing elective bariatric surgery.

Even though the marked improvement in liver fibrosis after laparoscopic Roux-en-Y gastric bypass (LRYGB), concern exists about the inaccessible gastric remnant if variceal bleeding occurs or if endoscopic access to the biliary tree is necessary. Laparoscopic sleeve gastrectomy (SG) has demonstrated to be well-tolerated in cirrhotic patients and can be as a risk reduction procedure. However, mortality rates are increased in cirrhotic patients undergoing bariatric surgery from 0.3% to 1.2%.

We present 2 cases of patients scheduled for LRYGB in who the intraoperative finding of a cirrhotic liver change the surgical conduct.

Case report:

A 38-year-old female with personal pathologic history of type II diabetes, hypothyroidism, morbid obesity, and NASH; BMI 51.6. A 39-year-old male with chronic alcoholism and multiple tattoos; BMI 40.3. Both patients were referred for LRYGB and preoperatory laboratory test results were within normal parameters.

Upon entering the abdominal cavity, dilated gastro-epiploic vessels, and a multinodular liver were found. With these findings the surgical procedure was changed to a sleeve gastrectomy on both patients. After cutting the gastroepiploic and short gastric vessels with bipolar energy, the gastric sleeve was manufactured using six golden lineal staplers, then a hemostatic running polyglicolic acid suture was placed. Pneumatic methylene blue test was performed without evidence of leaks. Liver wedge biopsies were taken and a drain placed.

They were admitted to the surgical ward, with NPO for 1 day, started liquid diet on the second day and a had a hidrosoluble contrast test was ordered, without evidence of leaks. They were discharged on PO day 3 on clear liquid diet. Pathological analysis demonstrated liver cirrhosis in both patients.

Conclusion:

Liver cirrhosis has an eightfold increase of risk for mortality and morbidity after abdominal surgery and most of the patients have concomitant comorbidities like metabolic syndrome and cardiovascular disease. Mal absorptive changes and GI tract modification associated with LRYGB might put these patient at risk for further complications.

Weight loss achieved with laparoscopic bariatric surgery in patients with cirrhosis offers a better outcome of their comorbidities, and even normalization in liver histology. Sleeve gastrectomy as a mainly restrictive procedure, is a safer option in patients with liver cirrhosis with reduction of the complication rate.

imageimage

2,377

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2015 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Surgery is Safer with Vaccination 1

Addressing Religious Concerns About COVID-19 Vaccine

This may be a difficult subject matter for you and your patient to talk about.  Be assured, all major organized religious groups encourage and recommend the COVID-19 vaccine. Listed below are references and websites you can direct your patient towards to help them make an informed decision with regards to their religious concerns against the […]

SAGES Statement on AAPI Violence

The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) stands in solidarity with the Asian American and Pacific Islander (AAPI) community. In the summer of 2020, SAGES released a statement condemning the violence, racism, and hatred toward the Black community in the wake of George Floyd and Breonna Taylor’s murders. It is with great sorrow […]

Free SAGES Webinar: Lessons from COVID on Living and Thriving as Surgeons

SAGES recognizes that the COVID-19 pandemic has had a big impact on surgical practice and in surgeon wellness. SAGES’ Reimagining the Practice of Surgery Taskforce will present “Finding the Opportunities: Lessons from COVID and How We Live and Thrive as Surgeons”  to look at ways in which innovative leadership at various levels may help transform […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
[email protected]
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2022 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2022 Society of American Gastrointestinal and Endoscopic Surgeons