Longitudinal Comparison of the Effect of Gastric Bypass to Sleeve Gastrectomy on Liver Function in a Bariatric Cohort: Tehran Obesity Treatment Study (TOTS)

Alireza Khlaj | Mohammad Ali Kalantar Motamedi | Maryam Mahdavi | Majid Valizadeh | Farhad Hosseinpanah | Maryam Barzin

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URL :   http://research.shahed.ac.ir/WSR/WebPages/Report/PaperView.aspx?PaperID=137918
Date :  2019/03/07
Publish in :    Obesity Surgery: The Journal of Metabolic Surgery and Allied Care
DOI :  https://doi.org/10.1007/s11695-018-3537-9
Link :  http://dx.doi.org/10.1007/s11695-018-3537-9
Keywords : Bariatricsurgery .Gastricbypass .Nonalcoholicfattyliverdisease .Liverfunctiontests .Morbidobesity

Abstract :

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Background Patients with morbid obesity commonly have fatty liver disease and elevated liver enzymes. While surgery effectively induces weight loss, bariatric techniques may differ regarding liver function improvement. Objectives To evaluate and compare the trends of liver function recovery after gastric bypass surgery (GB) with sleeve gastrectomy (SG). Setting University hospitals, Iran. Methods Adult bariatric candidateswithout a history ofalcohol consumption orother etiologiesofliver disease whounderwent SG (n =682) or GB ( n =355) were included. Trends of weight loss parameters and alanine transaminase (ALT), aspartate transaminase(AST),andalkalinephosphatase(ALP)at0,6(in90.4),12(in83.5),and24months(in67.1)werecompared using generalized estimating equations method. Results Overall, 1037 patients with mean age of 38.4±11.2 and mean body mass index of 44.9±6.2 kg/m2 were analyzed. Seventy-eightpercentofpatientshadfattyliverbyultrasound.BothGBandSGpatientslostsignificantweight,withGBpatients havingahigherpercentageofexcessweightlossat24months(80.1vs.75.9,Pbetween-group =.008).SGpatientsshowedmore favorable trends in liver chemistries with significantly lower ALT at 12 months and AST and ALP levels at 6 and 12 months. However,thetwogroupswerecomparableat24months.SignificantlymoreGBpatientsdevelopedhighALTat6andhighAST at 6 and 12 months. Undergoing GB was associated with smaller 0–12-month changes in ALT, AST, and ALP. Conclusions Bariatricsurgeryresultedinimprovementinliverfunctionparameters,withSGshowingadvantagesoverGBinthe first postoperative year.