BACKGROUND
The issue of the impact of bariatric operations on the evolution of non-alcoholic fatty liver disease (NAFLD) remains a subject of current medical field interest of this work discussion.
THE PURPOSE OF THE STUDY
To assess the impact of bariatric operations on the evolution of NAFLD and to reason of selecting the optimal surgical intervention in patients with NAFLD in obesity.
MATERIAL AND METHODS
The study included 120 patients after one of 3 types of bariatric operations: laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic mini-gastric bypass (MGB-OAGB). Liver biopsy was performed intraoperatively in all patients. The dynamics of the functional status of the liver in patients with histologically confirmed NAFLD was assessed. The follow-up period was 2 years, in-between control periods were 3, 6, 12, 18 months after surgery.
RESULTS
Initial signs of liver fibrosis according to biopsy and FibroTest were presented in 45.3—46.7% of patients, increased transaminases — 19.2—26.7%, markers of cholestasis— 73.1—76.9%, dyslipidemia— 84.6—86.7% of patients. In six months period the increasing levels of tramsaminases, FibroTest’s markers and cholestasis were noted, accompanied by clinical symptoms of nonalcoholic steatohepatitis (NASH) in 14.1% of cases after LSG, 19.2% after RYGB and 16.7% after MGB-OAGB. 11.5% of patients after RYGB and 10% of MGB-OAGB patients had the biochemical signs of the small hepatic insufficiency. Year after operations there was a statistically significant reduction in FibroTest, transaminases, markers of cholestasis, triglycerides (TG) and normalization of the lipidogram in comparison with the initial data was noted. There were no fatal outcomes of 105 (87.5%) patients who completed the two-year follow-up. The incidence of complications was higher after combined interventions; in patients with the F3—F4 stage of liver fibrosis initially, with body mass index (BMI) 40 kg/m2 and more, and in patients of 45 years and older, based on whom an algorithm for choosing the type of bariatric operations on patients with obesity and NAFLD was elaborated.
CONCLUSION
The effectiveness of bariatric operations in patients with obesity and NAFLD showed in this study. In 6 months after all types of surgery, there were transient signs of deterioration of evolution of NAFLD. The long-term data indicates statistically significantly improvement in both cases as in temporary deterioration and with the initial status of NAFLD. There is a significant note in this study of using the algorithm to improve the outcomes of surgical treatment on patients with obesity and NAFLD.
