Outcomes of bariatric surgery in patients with obesity and compensated liver cirrhosis

Background Obesity is a major health burden worldwide and is associated with nonalcoholic fatty liver disease, which can lead to cirrhosis. Bariatric surgery is increasingly being used to treat obesity, and the number of patients with obesity and cirrhosis undergoing bariatric surgery is also rising. However, the safety and feasibility of bariatric surgery in patients with obesity and cirrhosis are controversial. Objectives In this meta-analysis, we compared postoperative complications, mortality, and weight loss between patients with and without cirrhosis undergoing bariatric surgery. Setting An electronic search of Medline, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL). Methods Patient morbidity and mortality odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were assessed. Intraoperative and overall complications, length of hospital stay, in-hospital mortality, long-term mortality, and total weight loss were recorded. Results The literature search yielded 2977 articles. Eight studies were included in the analysis. Meta-analysis showed that the overall complications (OR: 2.1; 95% CI: 1.47–3.00; P < .0001), postoperative bleeding (OR: 2.22; 95% CI: 1.95–2.54; P < .00001), length of hospital stay (MD: .68; 95% CI: .14–1.19; P = .01), and in-hospital/90-day mortality (OR: 3.59; 95% CI: 2.84–4.54; P < .00001) were significantly higher in patients with compensated cirrhosis than in patients without cirrhosis. Intraoperative complications, operation time, major complications, and long-term mortality were similar between the groups. Total weight loss was also not significantly different between the groups. Conclusion Bariatric surgery can be considered only in highly selected patients with obesity and compensated cirrhosis.