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Impacts of bariatric surgery on adverse liver outcomes: a systematic review and meta-analysis

  • Author Footnotes
    ∗ These authors have contributed equally to this study.
    Guocheng Wang
    Footnotes
    ∗ These authors have contributed equally to this study.
    Affiliations
    Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, China

    Department of Gastrointestinal Surgery, Graduate School of Dalian Medical University, Dalian, China
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  • Author Footnotes
    ∗ These authors have contributed equally to this study.
    Yan Huang
    Footnotes
    ∗ These authors have contributed equally to this study.
    Affiliations
    Department of Head and Neck Surgery, Graduate School of Dalian Medical University, Dalian, China
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  • Haojun Yang
    Affiliations
    Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, China
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  • Huang Lin
    Affiliations
    Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, China
    Search for articles by this author
  • Shengfang Zhou
    Affiliations
    Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, China
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  • Jun Qian
    Correspondence
    Correspondence: Jun Qian, People’s Hospital of Nanjing Medical University, Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2, Changzhou, China.
    Affiliations
    Department of Gastrointestinal Surgery, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou, China
    Search for articles by this author
  • Author Footnotes
    ∗ These authors have contributed equally to this study.
Published:December 21, 2022DOI:https://doi.org/10.1016/j.soard.2022.12.025

      Highlights

      • This is the first systematic review and meta-analysis to examine the relationship between bariatric surgery and clinical outcomes in the liver.
      • Our meta-analysis showed that bariatric surgery reduced the risk of major hepatic adverse events.
      • Bariatric surgery also increased the risk of postoperative alcoholic cirrhosis.

      Abstract

      Background

      Bariatric surgery has been reported to improve degeneration, inflammation, and fibrosis in nonalcoholic fatty liver disease, but the effects of bariatric surgery on the associated clinical outcomes is not known.

      Objectives

      This work aimed to assess the impacts of bariatric surgery on adverse liver outcomes in people with obesity.

      Setting

      An electronic search was performed on EMBASE, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL).

      Methods

      The primary outcome was the incidence of adverse liver outcomes following bariatric surgery. Liver cancer, cirrhosis, liver transplantation, liver failure, and liver-related mortality were defined as adverse hepatic outcomes.

      Results

      We analyzed data from 18 studies comprising 16,800,287 post bariatric surgical patients and 10,595,752 control patients. We found that bariatric surgery reduced the risk of adverse liver outcomes in people with obesity (hazard ratio [HR] = .33, 95% confidence interval [CI] = .31–.34; I2 = 98.1%). The subgroup analysis showed that bariatric surgery reduced the risk of nonalcoholic cirrhosis (HR = .07, 95% CI = .06–.08; I2 = 99.3%) and liver cancer (HR = .37, 95% CI = .35–.39; I2 = 97.8%), although bariatric surgery may also increase the risk of postoperative alcoholic cirrhosis (HR = 1.32, 95% CI = 1.35–1.59).

      Conclusions

      This systematic review and meta-analysis revealed that bariatric surgery lowered the incidence of adverse hepatic outcomes. However, bariatric surgery may also increase the risk of alcoholic cirrhosis after surgery. Future randomized controlled trials are required to further investigate the effects of bariatric surgery on liver of people with obesity.

      Keywords

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