Robotic sleeve gastrectomy in a woman with class V obesity, cirrhosis and portal hypertension: A step forward.

Abstract: The increasing prevalence of obesity has made managing metabolic-dysfunction-associated steatotic liver disease and metabolic-dysfunction-associated steatohepatitis (MASH) with cirrhosis a significant challenge. This report details the case of a 53-year-old woman with class-V obesity (body mass index: 63.9 kg/m2) and MASH-associated decompensated cirrhosis with portal hypertension who underwent robotic sleeve gastrectomy (SG) after preoperative optimisation. Initial management involved stabilisation of variceal bleeding, a very-low-calorie diet, beta-blockers and continuous positive airway pressure, leading to improved liver function and Child-Turcotte-Pugh class improvement from B to A. The robotic SG, performed with meticulous intraoperative techniques to minimise bleeding and good post-operative care, resulted in favourable outcomes, including significant weight loss (44.8% total body weight loss) and improved liver parameters at 18-months. This case highlights the feasibility of metabolic and bariatric surgery in carefully selected cirrhotic patients following comprehensive optimisation and multidisciplinary care.