Laparoscopic Roux-En-Y Gastric Bypass Is Safe and Effective in Morbidly Obese Patients with Cirrhosis

Jayme B Stokes, MD, Nicholas H Pope, MD, Mohamed Dahman, MD, Sean C Kumer, MD, Timothy M Schmitt, MD, Bruce D Schirmer, MD, Peter T Hallowell, MD. University of Virginia

Background: Limited data currently exists regarding the performance of laparoscopic Rou-en-y gastric bypass (LRGB) in patients with cirrhosis. We evaluated our experience at a university tertiary referral center regarding the safety and efficacy of LRGB in morbidly obese patients with cirrhosis.

Methods: A retrospective review of all patients undergoing RGB at our institution between January 2002 and October 2009 was performed. Patients with biopsy-proven stage IV hepatic fibrosis (cirrhosis) were identified and the diagnosis confirmed by review of the histology. Demographics, surgical details, inpatient variables, complications, and weight loss were collected and analyzed.

Results: Between January 2002 and October 2009, 1,268 LGRB were performed and liver biopsies were performed in 83 (6.5%) patients. Of the 83 patients with liver biopsies, fibrosis was observed in 46 (55.4%) patients, 10 of which had cirrhosis. Six (60%) patients were female, the mean pre-bypass BMI was 56 (range 43-69), patients had a mean of 4 preoperative comorbidities, and the average preoperative MELD score was 7.8 (range 6-10). The diagnosis of cirrhosis was known preoperatively in three patients, one of which had ascites. Two patients (20%) were converted to an open procedure and there were no intraoperative complications or perioperative mortalities. The average operative time was 200 minutes (range 130-285), the mean estimated blood loss (EBL) was 200 ml and no patients required blood transfusions. The mean follow-up time was 20.8 months (range 6-74 months) and the mean percentage of excess weight lost was 61% (range 44-73) while the average post-bypass BMI was 36 (range 27-46).

Conclusions: Our study suggests that LRGB can be performed safely in morbidly obese patients with cirrhosis and is an effective approach for weight reduction surgery. Weight reduction surgery may be used as an effective therapy for weight loss in patients previously too obese to be listed for liver transplantation.