TH8.9 Impact of laparoscopic sleeve gastrectomy on fibrosis stage in patientswith child–A NASH–related cirrhosis

Abstract

Abstract Introduction Bariatric surgery can improve non-alcoholic fatty liver disease (NAFLD). This work endeavored to evaluate laparoscopic sleeve gastrectomy (LSG) in cases with compensated non-alcoholic steatohepatitis (NASH)-related cirrhosis and its impact on fibrosis stage. Methods A prospective work involved 132 cases with Child-A NASH-related cirrhosis suffering from morbid obesity scheduled for LSG. They had preoperative assessment, wedge biopsy, and ultrasound-guided true-cut liver biopsy after 30 months. Patients with F4 fibrosis were included. Liver condition was assessed based on NALFD Activity Score (NAS).primary outcome measure was the impact of LSG on fibrosis stage and its relation to weight loss. Results Analysis included only 71 patients who completed the 30-month follow-up period. By the end of follow-up interval, there was a substantial weight loss with a reasonable resolution of comorbidities. median NAS decreased from 6 (1–8) to 3 (0–6) after surgery. Fibrosis score regressed to F2 in 19 patients (26.8%) and F3 in 29 (40.8%). Patients with improved scores had a significantly higher amount of weight loss (p < 0.001). Improvement was more frequent in males (p = 0.007). By 30 months after treatment, 53.8% of cases with borderline NASH and 36.8% of those with probable NASH showed complete resolution, and 44.7% of patients with NASH showed improvement. Steatosis improved in 74.6% of patients. Conclusion Patients with NASH-related liver cirrhosis of Child class A, LSG may be a secure approach for the management of morbid obesity. It has a long-term benefit for both obesity and liver condition with significant improvement of steatosis, steatohepatitis, and fibrosis.