Page 12 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Comparative Study of the Effect of Various Bariatric Surgery

Methods on Liver Enzymes and Grading of Nonalcoholic

Fatty Liver Based on Ultrasound Scans in Children and Adults

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Azizollah Yousefi , Fateme Safari , Abdoreza Pazouki , Zeinab Pourzahabi , Sajede Riazi , Atefeh Talebi 6
AbstrAct
Introduction: Bariatric surgery is one of the most effective treatments for patients with morbid obesity. Rapid weight loss can accelerate the
process of fibrosis, and weight loss alone can improve the process of steatohepatitis. The conflict has confused the effect of these surgeries on
the severity of the fatty liver disease. This retrospective study aimed to compare the effects of different types of bariatric surgery on the grading
and severity of the nonalcoholic fatty liver disease (NAFLD).
Materials and methods: Using the National Obesity Surgery Database, data were extracted from 900 patients with a body mass index (BMI)
above 35 who underwent sleeve, classic bypass, or mini-bypass surgery or who did not undergo surgery for any reason. Body mass index,
aspartate transaminase (AST), alanine transaminase (ALT), NAFLD fibrosis score, and liver ultrasound were evaluated before and after surgery
in four different groups.
Results: All three surgical procedures effectively reduced BMI. Among the various surgical procedures, the rate of BMI reduction was significantly
higher in the mini-gastric bypass procedure than in the other two methods. The reduction of AST and ALT was significant in all three surgical
methods compared to the nonsurgical group, with the highest reduction in sleeve surgery. Fatty liver based on ultrasound in the nonsurgical
group in the second time got worse but improved significantly in all the operated groups, and all these changes including the development
of fatty liver in the nonsurgical group and its improvement in the operated groups were significant (p <0.05) and NAFLD fibrosis score (NFS)
decreased in all groups. This reduction was small and insignificant for the nonsurgical group while it was significant in the three operated groups.
Keywords: Bariatric surgery, Fatty liver, Liver function test, Nonalcoholic fatty liver disease, Radiologic information, Sonography.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1529

IntroductIon 1 Pediatric Growth and Development Research Center, Institute of
Given the increasing prevalence of the Western lifestyle, and its Endocrinology and Metabolism, Iran University of Medical Sciences,
significant complications such as diabetes, metabolic syndrome, Tehran, Iran
and obesity, mortality due to the complications of these diseases 2 Department of Pediatrics, School of Medicine, Iran University of
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constitute a major share of the causes of overall mortality. Obviously, Medical Sciences, Tehran, Iran
many of these complications can be prevented by early diagnosis and 3,5 Minimally Invasive Surgery Research Center, Iran University of Medical
current effective treatments, as well as the development of preventive Sciences, Center of Excellence for Minimally Invasive Surgery Training,
approaches. Along with the increasing prevalence of obesity, the Iran University of Medical Sciences, Center of Excellence of European
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related diseases also find a special place. With a prevalence of about Branch of International Federation for Surgery of Obesity, Tehran, Iran
30% in the general population and about 90% in obese individuals, 4 Pediatric Chronic Kidney Disease Research Center, Department
NAFLD seems to be the most common cause of cirrhosis and liver of Pediatric Nephrology, Children Medical Center Hospital, Tehran
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transplantation. Obesity surgery, the most effective and lasting University of Medical Sciences, Tehran, Iran
method in weight loss, is currently considered an effective method 6 Colorectal Research Center, Rasool Akram Hospital, Iran University of
in improving the complications of obesity, including metabolic Medical Sciences, Tehran, Iran
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syndrome and NAFLD. Bariatric surgery methods are among Corresponding Author: Zeinab Pourzahabi, Pediatric Chronic Kidney
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relatively new treatment methods for patients with morbid obesity. Disease Research Center, Department of Pediatric Nephrology, Children
Despite their relatively short lifespan, such surgeries have been able Medical Center Hospital, Tehran University of Medical Sciences, Tehran,
to gain a prominent place among the available treatments. However, Iran, Phone: +00989128398784, e-mail: zeinab.purzahabi@gmail.com
due to the lack of long-term studies, the complications of these How to cite this article: Yousefi A, Safari F, Pazouki A, et al. Comparative
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surgeries are not yet fully understood. Rapid weight loss, which Study of the Effect of Various Bariatric Surgery Methods on Liver
is one of the known complications of such surgeries, can increase Enzymes and Grading of Nonalcoholic Fatty Liver Based on Ultrasound
fibrosis in these patients; on the other hand, weight loss alone can Scans in Children and Adults. World J Lap Surg 2022;15(2):108–115.
improve steatohepatitis in obese patients. This conflict has confused Source of support: Nil
the effect of bariatric surgery on the incidence and severity of fatty Conflict of interest: None
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liver disease. Many studies have been performed on the effects of
some bariatric surgery methods on liver enzymes, liver steatosis, and
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pathological findings of non-alcoholic steatohepatitis (NASH), while little attention. Fewer studies have been performed on the effects of
some other methods such as mini-gastric bypass have received very bariatric surgery, imaging findings and fibrosis based on non-invasive
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