Long-Term Outcomes of Liver Pathology Following a Sleeve Gastrectomy.

IF 1.1 4区 医学 Q3 SURGERY
Lila Brody, James Alex Randall, Fatima Khambaty, Rob Young, Parini Shah, R Natalie Reed
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引用次数: 0

Abstract

Introduction: The rising prevalence of obesity in the United States is paralleled by an increase in type II diabetes (T2D) and metabolic-associated steatotic liver disease. While lifestyle changes often do not afford sustainable weight loss, bariatric surgery, particularly sleeve gastrectomy (SG), offers a durable solution. This study investigates long-term outcomes in Veterans who underwent SG with concurrent liver biopsy. Methods: All patients undergoing SG with a liver biopsy from January 2018 to March 2021 were included. Baseline demographics and comorbidities included age, gender, race, preoperative BMI, hemoglobin A1c (HgbA1c), T2D, hypertension (HTN), gastroesophageal reflux disease (GERD), obstructive sleep apnea (OSA), and presence of steatosis and fibrosis. Patients were followed postoperatively at 1, 3, and 5 years. Patient demographics and comorbidities were stratified by liver scores and compared pre- and postoperatively. A paired t-test compared variables. Multivariate linear regression assessed associations between liver pathology and BMI. Multivariate logistic regression analyzed associations between comorbidities and liver pathology. A P < .05 was significant. Results: A total of 95 patients underwent a laparoscopic SG with a liver biopsy. There was a level of steatosis (81%) or fibrosis (76.8%) in the majority of biopsies. For the entire cohort, there was a significant BMI reduction from baseline (40.6 ± 3.0 kg/m2) at 1, 3, and 5 years (33.9 ± 4.2, 35.0 ± 4.6, 34.7 ± 4.9 kg/m2; P < .001). At 5 years, % total weight loss (TWL) for no, low, and high liver scores was 18.3 ± 7.5, 13.5 ± 1.6, and 13.7 ± 2.5(P = .82). At 5 years postoperatively, there were significant reductions in mean HgbA1c level (6.2 versus 5.7, P < .001), T2D (47.4% versus 36.8%, P < .001), HTN (56.8% versus 39.0%, P < .001), GERD (49.5% versus 31.6%, P < .001), and OSA (66.3% versus 42.1%, P < .001). There was no significant difference in any postoperative comorbidity, BMI, or %TWL based on pathological liver scores (P > .05). Conclusion: This study underscores the long-term efficacy of SG in a predominantly African American Veteran cohort, irrespective of liver pathology. These results advocate for bariatric surgery to treat obese patients with liver disease, and even those with advanced hepatic conditions can achieve substantial health benefits.

袖式胃切除术后肝脏病理的长期预后。
在美国,肥胖患病率的上升与II型糖尿病(T2D)和代谢相关脂肪变性肝病的增加是平行的。虽然生活方式的改变往往无法承受持续的减肥,但减肥手术,尤其是袖式胃切除术(SG),提供了一个持久的解决方案。本研究调查了接受SG并发肝活检的退伍军人的长期预后。方法:纳入2018年1月至2021年3月期间接受SG肝活检的所有患者。基线人口统计学和合并症包括年龄、性别、种族、术前BMI、血红蛋白A1c (HgbA1c)、T2D、高血压(HTN)、胃食管反流病(GERD)、阻塞性睡眠呼吸暂停(OSA)以及脂肪变性和纤维化的存在。术后随访1年、3年和5年。根据肝脏评分对患者人口统计学和合并症进行分层,并对术前和术后进行比较。配对t检验比较变量。多变量线性回归评估肝脏病理与BMI之间的关系。多因素logistic回归分析了合并症与肝脏病理之间的关系。P < 0.05差异有统计学意义。结果:共有95例患者接受了腹腔镜下肝活检。在大多数活检中存在脂肪变性(81%)或纤维化(76.8%)。在整个队列中,在1,3和5年(33.9±4.2,35.0±4.6,34.7±4.9 kg/m2; P < .001), BMI从基线(40.6±3.0 kg/m2)显著下降。5年时,无肝评分、低肝评分和高肝评分组的总体重减轻(TWL)百分比分别为18.3±7.5、13.5±1.6和13.7±2.5(P = 0.82)。术后5年,患者的平均糖化血红蛋白水平(6.2比5.7,P < 0.001)、T2D水平(47.4%比36.8%,P < 0.001)、HTN水平(56.8%比39.0%,P < 0.001)、GERD水平(49.5%比31.6%,P < 0.001)和OSA水平(66.3%比42.1%,P < 0.001)均显著降低。两组术后合并症、BMI或基于病理肝脏评分的%TWL均无显著差异(P < 0.05)。结论:本研究强调了SG在非裔美国退伍军人群体中的长期疗效,与肝脏病理无关。这些结果提倡通过减肥手术治疗伴有肝脏疾病的肥胖患者,甚至那些患有晚期肝脏疾病的患者也能获得实质性的健康益处。
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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
163
审稿时长
3 months
期刊介绍: Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.
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