Universidade Federal do Ceará, Department of Surgery - Fortaleza (CE), Brazil.
Walter Cantídeo University Hospital, Liver Transplant Unit - Fortaleza (CE), Brazil.
Arq Bras Cir Dig. 2022 Aug 26;35:e1671. doi: 10.1590/0102-672020220002e1671. eCollection 2022.
Nonalcoholic hepatic steatosis is found in most obese patients and has a strong association with metabolic syndrome. The Roux-en-Y gastric bypass and the sleeve gastrectomy are the two techniques of bariatric surgery. Patients who underwent bariatric surgery have regression of nonalcoholic steatohepatitis due to a reduction in body mass index and changes in incretin hormones.
This study aimed to analyze the acuity of elastography in the regression of hepatic steatosis and fibrosis in obese patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy 2 months after surgery.
Patients in the preoperative period of bariatric surgery underwent an anthropometric evaluation and hepatic elastography to quantify fibrosis and hepatic steatosis. Two months after surgery, the same evaluation was performed again.
All 17 patients who met the inclusion criteria participated in the study. Out of this, nine underwent sleeve gastrectomy, and eight underwent Roux-en-Y gastric bypass. The Roux-en-Y gastric bypass group had lower fibrosis levels postoperatively compared to preoperatively (p=0.029, p<0.05). As for steatosis, patients who underwent Roux-en-Y gastric bypass had lower postoperative values (p=0.01, p<0.05). There was also a reduction in fibrosis postoperatively in the sleeve gastrectomy group compared to preoperatively (p=0.037, p<0.05).
Elastography accurately demonstrated decreased hepatic steatosis and fibrosis in the early postoperative period of bariatric surgery. Moreover, Roux-en-Y gastric bypass and sleeve gastrectomy are suitable surgical methods to improve hepatic steatosis and fibrosis within 2 months postoperatively.
非酒精性肝脂肪变性在大多数肥胖患者中都有发现，并且与代谢综合征密切相关。Roux-en-Y 胃旁路术和袖状胃切除术是两种减重手术技术。接受减重手术的患者由于体重指数的降低和肠促胰岛素激素的变化，非酒精性脂肪性肝炎得到了缓解。
本研究旨在分析肥胖患者在接受 Roux-en-Y 胃旁路术和袖状胃切除术 2 个月后，通过肝脏弹性成像分析肝脂肪变性和纤维化的缓解程度。
在接受减重手术的术前阶段，患者接受了人体测量评估和肝脏弹性成像，以量化纤维化和肝脂肪变性。术后 2 个月，再次进行相同的评估。
所有符合纳入标准的 17 名患者均参与了本研究。其中 9 名患者接受了袖状胃切除术，8 名患者接受了 Roux-en-Y 胃旁路术。与术前相比，Roux-en-Y 胃旁路术组术后纤维化水平较低（p=0.029，p<0.05）。至于脂肪变性，接受 Roux-en-Y 胃旁路术的患者术后数值较低（p=0.01，p<0.05）。袖状胃切除术组术后纤维化水平也较术前降低（p=0.037，p<0.05）。
弹性成像术在减重手术后的早期准确显示肝脂肪变性和纤维化程度降低。此外，Roux-en-Y 胃旁路术和袖状胃切除术是在术后 2 个月内改善肝脂肪变性和纤维化的合适手术方法。
