Fonseca Pandora, Pereira Leonardo, Braga João Gabriel, Scremin Giovanna Macanhã, de Araujo Luísa, Alves Julia, de França Gabriel, Bregion Pedro, Rego Rafael, Farias Maria, Ivano Victor
Federal University of Campina Grande, Cajazeiras, Brazil.
Fluminense Federal University, Niterói, Brazil.
Obes Surg. 2025 Sep 3. doi: 10.1007/s11695-025-08189-6.
The global rise in obesity and liver disease underscores the significance of bariatric and metabolic surgery (BMS) in treating severe obesity and improving liver function. Although liver failure is often considered a contraindication for elective surgeries, the role of bariatric surgery in patients with compensated cirrhosis has been increasingly explored.
We systematically searched PubMed, Embase, and Cochrane without temporal restrictions, in January 2025 for randomized controlled trials and observational studies. Statistical analyses were performed using R software. Heterogeneity was assessed with I2 statistics.
This meta-analysis evaluated BMS's efficacy and safety in patients with cirrhosis by analyzing 26 studies with 22,489 participants. Mortality was 3.33% (95% CI [2.06; 5.35]; I2 = 96.7%). Early postoperative complications were 14.0% (95% CI [7.56; 24.49]; I2 = 90.3%). Patients with cirrhosis had a significant weight loss after 1 year of follow-up (MD -43.06 kg; 95% CI [-70.93; -15.19]; P < 0.0001; I2 = 94.0%), BMI (MD -10.79 kg/m2; 95% CI [-14.45,-7.12]; P < 0.01; I2 = 66.2%), excess weight loss in percentage-EWL% 62.81% (95% CI [52.56; 73.96]; I2 = 78%) and total weight loss in percentage TWL% (26.43% 95% CI [23.89; 28.96]; I2 = 69.3%). The length of stay was 3.77 days ( 95% CI [3.13; 4.42]; I2 = 99.1%).
Despite increased perioperative risks, mortality remained low, and patients with compensated cirrhosis achieved substantial weight and metabolic improvements, supporting BMS's safety and benefits with proper patient selection.
全球肥胖和肝脏疾病的增加凸显了减重代谢手术（BMS）在治疗重度肥胖和改善肝功能方面的重要性。尽管肝衰竭通常被视为择期手术的禁忌症，但减重手术在代偿期肝硬化患者中的作用已得到越来越多的探索。
我们于2025年1月在PubMed、Embase和Cochrane上进行了无时间限制的系统检索，以查找随机对照试验和观察性研究。使用R软件进行统计分析。用I²统计量评估异质性。
本荟萃分析通过分析26项研究中的22489名参与者，评估了BMS在肝硬化患者中的疗效和安全性。死亡率为3.33%（95%CI[2.06；5.35]；I²=96.7%）。术后早期并发症发生率为14.0%（95%CI[7.56；24.49]；I²=90.3%）。肝硬化患者在随访1年后体重显著减轻（MD -43.06kg；95%CI[-70.93；-15.19]；P<0.0001；I²=94.0%），BMI（MD -10.79kg/m²；95%CI[-14.45，-7.12]；P<0.01；I²=66.2%），超重减轻百分比-EWL%为62.81%（95%CI[52.56；73.96]；I²=78%），总体重减轻百分比-TWL%为（26.43% 95%CI[23.89；28.96]；I²=69.3%）。住院时间为3.77天（95%CI[3.13；4.42]；I²=99.1%）。
尽管围手术期风险增加，但死亡率仍然较低，代偿期肝硬化患者的体重和代谢状况有显著改善，这支持了在适当选择患者的情况下BMS的安全性和益处。
