General Surgery Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, 11311, Egypt.
Surg Endosc. 2021 Apr;35(4):1889-1894. doi: 10.1007/s00464-020-07725-y. Epub 2020 Jun 16.
Weight reduction can effectively improve nonalcoholic fatty liver disease (NAFLD), which is a constant companion of severe obesity. This study aimed to determine the effect of one-anastomosis gastric bypass (OAGB) on pathological liver changes in severely obese cases with NAFLD.
The present prospective research comprised 67 subjects with morbid obesity scheduled for OAGB during the period from February 2015 to August 2018. Clinical, biological, and histologic data were evaluated pre and 15 months postoperatively.
Fifteen months after surgery, a considerable reduction was noted in the grades of fat deposition, liver cell ballooning, and lobular inflammatory changes, in addition to the total NAS score. Fifteen months after surgery, nonalcoholic steatohepatitis (NASH) disappeared in 42% of the patients. A significant regression of fibrosis stage occurred after surgery in 79.1% of patients (p < 0.001). After surgery, patients had substantial reductions in aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, HbA1c, total cholesterol, and Low-density lipoprotein (p < 0.001, for all comparisons). Diabetes mellitus, hypertension, and dyslipidemia resolved in 54%, 59%, and 69% of the patients, respectively.
OAGB resolved NASH from nearly 42% of patients and reduced the histological features of NAFLD 15 months after surgery. Bariatric procedures might be adopted as a therapeutic modality in severely obese cases with NAFLD after the failure of lifestyle modifications.
减肥可以有效改善非酒精性脂肪性肝病（NAFLD），这是非酒精性脂肪肝的一个伴随症状。本研究旨在确定单吻合胃旁路术（OAGB）对伴有非酒精性脂肪肝的严重肥胖患者的肝病理变化的影响。
本前瞻性研究纳入了 2015 年 2 月至 2018 年 8 月期间因 OAGB 而接受手术的 67 例病态肥胖患者。在术前和术后 15 个月评估了临床、生物学和组织学数据。
术后 15 个月，脂肪沉积、肝细胞气球样变和小叶炎症改变的程度以及总 NAS 评分均显著降低。术后 15 个月，42%的患者非酒精性脂肪性肝炎（NASH）消失。79.1%的患者术后纤维化分期显著改善（p < 0.001）。术后，患者的天冬氨酸转氨酶、丙氨酸转氨酶、γ-谷氨酰转移酶、HbA1c、总胆固醇和低密度脂蛋白均显著降低（p < 0.001，所有比较）。54%的患者糖尿病、59%的患者高血压和 69%的患者血脂异常得到缓解。
OAGB 使近 42%的患者 NASH 得到缓解，并在术后 15 个月减轻了 NAFLD 的组织学特征。在生活方式改变失败后，肥胖症患者可采用减重手术作为治疗方法。
