Introduction
Patients and Methods
Results
Demographics and Initial Body Weight
Study population, n = 10 | Before bariatric surgery | Peak of liver dysfunction |
---|---|---|
Female sex, % (n) | 80 (8/10) | 80 (8/10) |
Age in years, median (range) | 40 (21–66) | 48 (22–66) |
BMI (kg/m2), median (range) | 49.2 (38–64) | 22.2 (20.8–30.5) |
NAFLD | ||
Liver disease, % (n) | 60 (6/10) | 100 (10/10) |
Steatosis/fibrosis, % (n) | 50 (5/10) | 70 (7/10) |
Cirrhosis, % (n) | 10 (1/10) | 30 (3/10) |
No liver disease | 30 (3/10) | 0 (0/10) |
Missing, % (n) | 10 (1/10) | 0 (0/10) |
Liver enzymes | ||
AST (U/L), median (range) | 25 (14.5–57) | 32.5 (14–258) |
ALT (U/L), median (range) | 38 (12.5–127) | 26 (11–230) |
GGT (U/L), median (range) | 33 (12–110) | 38.5 (11–468) |
Hypercholesterolemia, % (n) | 20 (2) | 0 (0) |
Cholesterol (mg/dl), median (range) | 175.3 (109.5–228) | 98.5 (66–146) |
HDL (mg/dl), median (range) | 52.5 (42–59) | 42 (4–54) |
LDL (mg/dl), median (range) | 111.2 (92.1–152.8) | 37.2 (11.2–92.2) |
Hypertriglyceridemia, % (n) | 20 (2) | 10 (1) |
Triglycerides (mg/dl), median (range) | 92 (46–152) | 50.5 (28–249) |
T2DM, % (n) | 10 (1) | 0 (0) |
OAD, % (n) | 10 (1) | 0 (0) |
Insulin, % (n) | 0 (0) | 0 (0) |
HbA1c (%), median (range) | 5.2 (4.7–5.7) | 3.9 (3.7–4) |
aHTN, % (n) | 40% (4) | 10 (1) |
Hyperuricemia, % (n) | 20% (2) | 0 (0) |
Obstructive sleep apnea, % (n) | 0 (0) | 0 (0) |
CAD, % (n) | 0 (0) | 0 (0) |
Congestive heart failure, % (n) | 10 (1) | 10 (1) |
PH, % (n) | 10 (1) | 10 (1) |
Surgical Procedures and Weight Loss
Patient | Type of surgical intervention | Initial BMI (kg/m2) | BMI min (kg/m2) | ΔBMI (kg/m2) | %TWL (%) | %EWL (%) | Clinical presentation | Onset of symptoms (months) | Treatment |
---|---|---|---|---|---|---|---|---|---|
1
| RYGB (BPL 60 cm, AL 200 cm, CL 200 cm) | 48.2 | 30.00 | 18.2 | 37.7 | 78.3 | No discomfort | 84 | |
Weight loss of unknown origin | 48.2 | 21.90 | 26.3 | 54.6 | 113.3 | Dysphagia, epigastric pain, diarrhea, sarcopenia, hypoalbuminemia, leg edema, thrombocytopenia, impaired coagulation, hepatomegaly | 4 | Gastric remnant feeding tube, GB reversal | |
2
| Gastric band | 38 | 18.40 | 19.6 | 51.6 | 155.5 | Weight regain, dysphagia, band infection, pancytopenia, elevated liver enzymes | 144 | Band removal |
OAGB (BPL 175 cm, CL 500 cm) | 33.3 | 22.03 | 11.3 | 33.8 | 125.4 | Sarcopenia, ascites, HE, splenomegaly, variceal bleeding, leg edema, thrombocytopenia, impaired coagulation, hypoalbuminemia | 5 | LT | |
3
| OAGB (BPL 370 cm, CL 320 cm) | 42.9 | 20.80 | 22.1 | 51.5 | 123.7 | Ascites, elevated liver enzymes, hepatosplenomegaly, pancytopenia | 12 | Conversion to RYGB, CL lengthening (BPL 220, AL 50 cm, CL420cm) |
4
| RYGB (BPL 60 cm, AL 150 cm CL200) | 50.2 | 31.90 | 18.3 | 36.5 | 75.4 | Weight regain | 85 | Distal GB |
distal GB (BPL 60 cm, AL 275 cm, CL 75 cm) | 44.5 | 28.70 | 15.8 | 35.5 | 85.2 | General fatigue, impaired coagulation, elevated liver enzymes, hypoalbuminemia, leg edema | 12 | Gastric remnant feeding tube, CL lengthening (BPL60cm, AL 150 cm, CL 200 cm) | |
5
| RYGB (BPL 60 cm AL 200 cm, CL 425 cm) | 44.1 | 22.70 | 21.4 | 48.5 | 111.8 | Weight regain | 96 | Distal GB |
distal GB (BPL 400 cm, AL 200 cm, CL 85 cm) | 28.1 | 20.30 | 7.8 | 27.8 | 124.6 | Diarrhea, dumping syndrome, hypoalbuminemia, leg edema, impaired coagulation, SIBO, lactose malabsorption, hepatomegaly | 6 | CL lengthening (BPL 250 cm, AL 200 cm, CL 235 cm) | |
6
| RYGB (limb length unknown) | 58 | 28.70 | 29.3 | 50.5 | 88.8 | Epigastric pain, elevated liver enzymes, thrombocytopenia, impaired coagulation, hypoalbuminemia, leg edema, ascites, HE, hepatosplenomegaly | 2 | Conservative |
7
| RYGB (BPL 155 cm, AL 210 cm, CL 35 cm) | 53.4 | 26.60 | 26.8 | 50.2 | 94.4 | Fatigue, ascites, leg edema, sarcopenia, hepatosplenomegaly, pleural effusions, hypoalbuminemia, elevated liver enzymes, thrombocytopenia | 24 | Gastric remnant feeding tube, CL lengthening (BPL 15 cm, AL 210, CL 175 cm) |
8
| OAGB (BPL 265 cm, CL 395 cm) | 40.8 | 21.70 | 19.1 | 46.7 | 120.7 | Fatigue, ascites, leg edema, sarcopenia, hypoalbuminemia, steatorrhea, diarrhea, thrombocytopenia, impaired coagulation, splenomegaly | 35 | Conversion to RYGB, CL lengthening to 530 cm (BPL 60, AL 70) |
9
| Gastric band | 58.4 | 56.30 | 2.1 | 3.7 | 6.5 | No weight loss | 108 | Band removal |
OAGB (BPL 200 cm, CL 375 cm) | 57.6 | 36.80 | 20.8 | 37.0 | 64.7 | Diarrhea, SIBO | 36 | ||
Weight loss of unknown origin | 57.6 | 22.40 | 35.2 | 61.7 | 107.8 | Dysphagia, epigastric pain, elevated liver enzymes, sarcopenia, pleural effusions, ascites, hypoalbuminemia, HE, steatorrhea, diarrhea | 5 | Conversion to RYGB, CL lengthening to 495 cm (BPL 30 cm, AL 50 cm) | |
10
| OAGB (BPL 95 cm, CL 275 cm) | 64 | 30.5 | 33.5 | 52.4 | 85.9 | Fatigue, dysphagia, ascites, leg edema, pulmonary effusion, sarcopenia, hypoalbuminemia, jaundice, thrombocytopenia, elevated liver enzymes, impaired coagulation, hepatosplenomegaly | 20 | Conversion to RYGB, CL lengthening to 295 cm (BPL 35 cm, AL 40 cm) |