Mendoza Yuly P, Becchetti Chiara, Wan Tao, Nett Philipp, Rodrigues Susana G, Dufour Jean-François, Berzigotti Annalisa
University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
Department of Biomedical Research, University of Bern, Bern, Switzerland.
Obes Surg. 2021 Jun;31(6):2817-2822. doi: 10.1007/s11695-021-05237-9. Epub 2021 Jan 23.
Factors and outcomes associated with decompensation of liver disease and liver failure in obese patients who underwent modern bariatric surgery are unclear. We present here a cohort of seventeen consecutive patients referred because of decompensation of liver disease following laparoscopic bariatric surgery. All patients showed signs of malnutrition (sarcopenia in 76.5%). In ten (58.8%), decompensation was associated with alcohol ingestion, which started after bariatric surgery in six patients. One patient died and three patients required liver transplantation, in one case preceded by transjugular intrahepatic portosystemic shunt (TIPS). However, thirteen patients achieved stabilization or full re-compensation with medical therapy and nutritional support. Our cases underline the risk of alcohol intake and malnutrition after laparoscopic bariatric surgery as causes of severe liver decompensation and underline the need for careful interdisciplinary care of these patients after surgery to early identify and treat alcohol misuse, malnutrition, and liver disease.
接受现代减肥手术的肥胖患者中，与肝病失代偿和肝衰竭相关的因素及结果尚不清楚。我们在此报告一组连续17例因腹腔镜减肥手术后肝病失代偿而转诊的患者。所有患者均表现出营养不良的迹象（76.5%有肌肉减少症）。10例（58.8%）患者的失代偿与酒精摄入有关，其中6例患者在减肥手术后开始饮酒。1例患者死亡，3例患者需要肝移植，其中1例在肝移植前进行了经颈静脉肝内门体分流术（TIPS）。然而，13例患者通过药物治疗和营养支持实现了病情稳定或完全代偿。我们的病例强调了腹腔镜减肥手术后酒精摄入和营养不良作为严重肝失代偿原因的风险，并强调了术后对这些患者进行仔细的多学科护理以早期识别和治疗酒精滥用、营养不良和肝病的必要性。
