P-1 EFFECTIVENESS AND SAFETY OF BARIATRIC SURGERY IN PATIENTS WITH ADVANCED HEPATIC FIBROSIS SECONDARY TO METABOLIC ASSOCIATED FATTY LIVER DISEASE IN A TERTIARY REFERENCE HOSPITAL

Abstract

Introduction and Objectives

There is limited knowledge regarding the outcomes of patients with Metabolic Associated Fatty Liver Disease (MAFLD) and hepatic fibrosis who undergo bariatric surgery. We aimed to evaluate the benefits and safety of bariatric surgery in patients with MAFLD and advanced hepatic fibrosis (F3-F4).

Patients and Methods

An observational and prospective study that included participants from the MAFLD outpatient clinic of a Brazilian tertiary hospital, who had grade 3 or 4 hepatic fibrosis on biopsy or transient hepatic elastography and underwent bariatric surgery for obesity treatment.

Results

A total of 25 patients were included, with 80% being female. The mean age was 54 years and the surgical procedures performed included gastric bypass (44%) and sleeve gastrectomy (56%). The body mass index ranged from 35 kg/m² to 63 kg/m², with a median of 41 kg/m². Regarding comorbidity, 68% had hypertension, 80% had type 2 diabetes or insulin resistance, and 48% had dyslipidemia. Furthermore, 64% were diagnosed with grade 3 fibrosis and 36% already had cirrhosis, with 4 of them presenting portal hypertension with esophageal varices, but Child-Pugh A. After the procedure, weight loss ranged from 18% to 47% with a median follow-up of 3 years, with higher percentages achieved with gastric bypass (Table 1). Regarding hepatic fibrosis, 50% showed regression to less advanced stages. Among patients with portal Hypertension, 2 of them had subsequent endoscopic examinations without detection of esophagogastric varices. There were no complications related to hepatic decompensation; however one patient developed postoperative pulmonary thromboembolism without severity.

Conclusions

Bariatric surgery, either gastric bypass or sleeve gastrectomy, resulted in significant weight loss in patients with advanced hepatic fibrosis and regression of fibrosis, without serious outcomes or hepatic decompensation in a small cohort in a tertiary reference hospital.