Page 18 - World Journal of Laparoscopic Surgery

Comparative Study of the Effect of Various Bariatric Surgery Methods
Table 3: Comparison of fatty liver grade in different groups before surgery
Groups
Fatty liver grade Control Gastric sleeve Mini-gastric bypass RY gastric bypass p
Grade I 53 94 82 97
34.9% 37.8% 32.8% 39.0%
Grade II 73 113 114 109 0.19
48.2% 45.2% 45.6% 43.5%
Grade III 26 43 54 44
16.9% 17.0% 21.6% 17.5%

Table 4: Comparison of fatty liver grade in different groups 12 months after surgery
Groups
Fatty liver grade Control Gastric sleeve Mini-gastric bypass RY gastric bypass p
Grade I 19 11 103 32
12.7% 91.7% 91.2% 100.0%
Grade II 44 1 10 0 <0.001
29.3% 8.3% 8.8% 0.0%
Grade III 87 0 0 0
58% 0 0 0

A review by Chavez–Tapia et al. showed that to date, no clinical patients, while these two findings were found in people who
trials have been conducted on the effect of obesity surgery on used the gastric balloon had lost significantly less weight and was
NAFLD in obese patients. Only 21 retrospective and prospective almost insignificant in people who had lost weight by nonsurgical
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studies were performed in which the severity of steatosis and methods. Also, in another study conducted by Nascimento
inflammation improved, and four studies showed an increase in et al. on 40 people, it was shown that the degree of liver fibrosis
postoperative fibrosis. 7 measured by NFS in patients undergoing surgery in private centers
In a study by Karcz et al. 236 obese patients underwent from 7.1 to 0% and in patients undergoing surgery in governmental
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laparoscopic sleeve surgery and were followed up for 3 years. The centers decreased from 30.8 to 23%. Therefore, the results of these
results of this study showed that, firstly, there is a strong association studies indicate the positive effect of surgery on the improvement
between high levels of transaminases and NASH diagnosed based of NFS, which is largely in line with our research findings. In our
on pathology. Among the patients with NASH, the amount of liver study, all three types of surgery significantly reduced the risk of
enzymes decreased by more than 50% after surgery. The results of liver fibrosis during 6 and 12 months of follow-up in patients, such
this study are somewhat consistent with the findings of our study. that the rate of reduction of high-risk NSF (or NSF above 0.67)
However, in our study, the rate of decrease in the level of liver enzymes of patients was 13.8, 24.5, and 19.6%, respectively, in the gastric
after surgery was less than this report, which probably affects the sleeve, mini-gastric bypass and RY gastric bypass groups 12 months
baseline levels of these enzymes and the disease grade, and the after surgery compared to before. On the other hand, the increase
number of patients. In our study, all three types of surgery significantly in patients with low-risk or NSF below –1.5 was 67.6, 65.0, and
reduced AST and ALT enzymes during 6 and 12 months follow-up, 74.4%, respectively, 12 months after surgery in the gastric sleeve,
such that the rate of AST reduction in patients were equal to 8.69, mini-gastric bypass and RY gastric bypass groups. Conversely, in
2.24, and 0.81%, respectively, in gastric sleeve, mini-gastric bypass, the control group, a 38.5% increase in the frequency of high-risk
and RY gastric bypass groups 12 months after surgery compared to NSF was observed in patients 12 months after surgery. So, these
before, and the rate of ALT reduction in patients were 19.58, 18.9, and results indicate that performing all three types of surgeries have
15.18%, respectively, in gastric sleeve, mini-gastric bypass, and RY a significant effect on reducing high-risk NSF in obese patients.
gastric bypass 12 months after surgery compared to before.
In another study, Aldoheyan et al. reported that fibrosis,
steatosis, and NASH improved to varying degrees at the end of 3 AcknowledgMents
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months in 27 patients undergoing obesity surgery. The findings The authors thank Ali Asghar Clinical Research Development Center
of this study are largely in line with the results of our research. for editorial and search assistance. We used data from National
Also, few studies have compared the effects of various surgical Obesity Surgery Database, Iran. The authors express their gratitude
procedures on liver and LFT tests. For example, Kalinowski et al. to National Obesity Surgery Database team who provided them
reported that LFT worsens shortly after RYGB surgery and returns such useful data.
to baseline after 1 year, and this increase in liver tests is less after
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sleeve surgery. In another study, Ruiz–Tovar et al. reported that references
hepatic steatosis evaluated by ultrasound completely improved 1. National Academies of Sciences Engineering, and Medicine. Obesity
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by up to 90% after sleeve surgery. In another study, Manco et al. in the early childhood years: state of the science and implementation
showed that sleeve surgery was able to completely eliminate of promising solutions: workshop summary. National Academies
NASH in all patients. It also reversed stage 2 fibrosis in 90% of Press; 2016. Ebook.

114 World Journal of Laparoscopic Surgery, Volume 15 Issue 2 (May–August 2022)