Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis

Surgery. 2004 Jan;135(1):48-58. doi: 10.1016/j.surg.2003.10.003.


Background: Both weight loss and gastrointestinal surgery for obesity can cause liver disease, making their role in the treatment of obesity-related liver disease controversial.

Methods: Six hundred eighty-nine severely obese women (n=551) and men (n=138), BMI=47+/-9 kg.m(-2) (mean+/-SD), without known liver disease, underwent biliopancreatic diversion (BPD) with liver biopsy. Fourteen patients (2%) had cryptogenic cirrhosis, 11 of whom underwent multiple repeat biopsies. After 38+/-18 kg weight loss, 104 of the 689 patients underwent routine second biopsies during reoperations 41+/-25 months after BPD. All biopsy specimens were graded for steatosis, fibrosis, and inflammation by a blinded hepatopathologist.

Results: All 689 patients lost weight accompanied by improvements in the metabolic syndrome. Among the 104 patients who underwent reoperation, severe fibrosis (grade 3-5) decreased in 28 whereas mild fibrosis (grade 1-2) appeared in 42. Increased fibrosis was related to low-normal serum albumin, uncontrolled diarrhea, low intake of alcohol, and menopausal status. Fibrosis and inflammation decreased over time (P<.01). The 11 patients with cirrhosis exhibited decreased fibrosis from a mean grade 5 to grade 3, as well as reduced inflammation, Mallory bodies, and glycogenated nuclei. Seven patients had disappearance and 2 regression of nodules and fibrous bridging.

Conclusions: The metabolic syndrome of obesity is a determinant of liver fibrosis and cirrhosis, treatable by substantial weight loss after malabsorptive surgery.

MeSH terms

  • Adult
  • Biliopancreatic Diversion*
  • Biopsy
  • Case-Control Studies
  • Fatty Liver / complications
  • Fatty Liver / pathology
  • Female
  • Hepatitis / complications
  • Hepatitis / pathology
  • Humans
  • Liver / pathology
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / pathology*
  • Male
  • Metabolic Syndrome / complications*
  • Metabolic Syndrome / etiology
  • Metabolic Syndrome / surgery*
  • Middle Aged
  • Obesity, Morbid / complications
  • Obesity, Morbid / physiopathology
  • Reoperation
  • Single-Blind Method
  • Treatment Outcome
  • Weight Loss