Treating Morbid Obesity in Patients with Liver Cirrhosis: Experience with Laparoscopic Adjustable Gastric Banding

Thomas Schnelldorfer, David M Brams, Lelan F Sillin, Pamela J O’Brien, Sara J Tortorici, Dmitry Nepomnayshy

Department of General Surgery, Lahey Clinic Medical Center, Tufts University School of Medicine, Burlington, MA

Introduction: Liver cirrhosis is increasingly diagnosed in morbidly obese patients. The indication of bariatric surgery in these high-risk patients with morbid obesity and liver cirrhosis is evolving. Furthermore, the outcome of laparoscopic adjustable gastric banding in this setting is unknown.

Methods: The records of 6 consecutive patients who underwent laparoscopic adjustable gastric banding for morbid obesity in the setting of diagnosed liver cirrhosis between 7/2007 and 6/2012 were retrieved from a prospective database. The median follow-up was 1.1 year (range 0.5 to 5.0 years).

Results: All 6 patients (age 37 to 65 years, 4 female) underwent laparoscopic adjustable gastric banding. At operation, the median BMI was 49 kg/m2, median MELD score was 6 (range 1 to 8), and median platelet count was 139 K/microL (range 39 to 246). Three patients had evidence of portal hypertension, 2 had intra-abdominal varices, and 1 had mild ascites. The etiology for cirrhosis was NASH in 3, chronic hepatitis C in 1, primary biliary cirrhosis in 1, and autoimmune hepatitis in 1, respectively. 30-day morbidity was 0%. However, 3 patients (50%) developed delayed port site complications on average 1.4 years after the operation, including hemorrhage causing port infection, ascites around the port, and primary port infection. Throughout the follow-up, liver disease remained stable with no significant change in MELD score, platelet count, or major complications from portal hypertension or ascites. Median weight loss at follow-up was 18 kg (range 9 to 48 kg), which corresponded to a loss in excess body weight of 28% (range 8 to 60%).

Conclusion: Despite the possibility of varices near the gastroesophageal junction, this study suggests that laparoscopic adjustable gastric banding appears to be safe for select patients with morbid obesity and liver cirrhosis. The rate of delayed port site complications is concerning, but due to the study’s sample size its significance is unknown. Hepatic function does not seem to be negatively affected and weight loss appears similar to patients without cirrhosis.

Session: Poster Presentation

Program Number: P211

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