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    • Implication of Bariatric Surgery on NAFLD in Obese Patients

    Ahmed Sobhy Abbass Ahmed Elsobky
    Assistant Professor, Ain Shams University, General Surgery Department

    Background: Bariatric surgery results in favorable loss of excess weight, changes in co-morbidities and improvement in quality of life. In patients with non-alcoholic liver disease, liver histology taken before or during surgery reveals several histological abnormalities. In a prospective study of patients previously submitted to bariatric surgery, we determined the changes in liver histology late after the surgery. Methods: These 36 patients (11 males, 25 females) had two liver biopsies, the first at the time of laparoscopic sleeve gastrectomy (14 patients ) and Laparoscopic OAGB ( 22 patients ),and the second after weight loss. Second biopsies were obtained from two groups: those requiring a subsequent laparoscopic procedure (n = 19) and those who accept for percutaneos biopsy (n = 17). All biopsies were scored, blinded to the patient’s identity and clinical condition, for individual histological features and for NASH stage and grade. Initial biopsies demonstrated NASH in 23 patients and steatosis in 12 patients. Repeat biopsies were taken at 25.6 ± 10 months (range, 9–51 months) after surgery. Results: Mean weight loss was 34.0±17 kg, and percentage of excess weight loss was 52±17%. There were major improvements in lobular steatosis, necroinflammatory changes, and fibrosis at the second biopsy (P<.001 for all). Portal abnormalities remained unchanged. Only four of the repeat biopsies fulfilled the criteria for NASH. There were 18 patients with an initial fibrosis score of 2 or more compared with 3 patients at follow-up (P < .001). Those with the metabolic syndrome (n = 23) had more extensive changes before surgery and greater improvement with weight loss. Conclusion: Bariatric surgery improves steatosis, necroinflammatory activity and hepatic fibrosis in patients with morbid obesity and NASH. It is followed by a dramatic improvement or normalization of liver histological abnormalities in the great majority of the patients. Keywords: Morbid obesity, gastric bypass, sleeve gastrectomy, liver histology, non-alcoholic fatty liver disease, hepatic steatosis. 

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