Liver steatosis and cholelithiasis in patients with morbid superobesity
https://doi.org/10.31146/1682-8658-ecg-180-8-45-49
Abstract
The aim of the study was to estimate the condition of gallbladder, extrahepatic bile ducts and liver in patients with morbid obesity before and after bariatric operations.
Materials and methods. 82 patients were operated on for obesity: 39 — for morbid obesity with a body mass index (BMI) of 40–49 and 43 — for super-obesity with a BMI of more than 50. Before and two years after the operation, the condition of the liver and bile ducts was studied based on ultrasound results.
Results. 75 patients (91.4%) were diagnosed with metabolic syndrome. The incidence of cholelithiasis in both groups was the same and in general was 32.93%. According to the results of the ultrasound examination in patients with morbid obesity, the utrasonographic fatty liver indicator (US-FLI) ranged from two to six points, with 61.54% of cases diagnosed with mild steatosis, 33.33% — with moderate severity, and 5.13% — with severe steatosis. In patients with superobesity, the US-FLI ranged from six to eight. Moderate steatosis was diagnosed in 41.86%, severe — in 58.14%.
Two years later, in group 1, 15 patients (38.36%) had no ultrasound signs of steatosis, and the remaining 24 (61.54%) had mild steatosis. In group 2, mild steatosis was detected in 48.84% of cases, moderate — in 39.53% and severe — in 11.63%.
Conclusion. The incidence of gallstone disease in patients with extreme degrees of obesity is 32.93% and does not depend on the body mass index. Correction of liver steatosis is more eff ective in patients with morbid obesity compared to patients with superobesity. In 11.63% of cases with superobesity and severe steatosis, the liver condition does not improve after bariatric surgery according to ultrasound data.
About the Authors
L. P. KotelnikovaRussian Federation
Liudmila P. Kotelnikova - MD, Professor, head of the Surgical department with the course of cardiovascular surgery and invasive cardiology.
614000, Perm, st. Petropavlovskaya, 26
R. A. Stepanov
Russian Federation
Ph. D., associated professor of the Surgical department with the course of cardiovascular surgery and invasive cardiology.
614000, Perm, st. Petropavlovskaya, 26
A. N. Fedachuk
Russian Federation
Ph. D., surgeon of the 1st Surgical department.
614990, Perm, st. Pushkin, 85
S. V. Grebenkina
Russian Federation
Doctor of functional diagnostics.
614990, Perm, st. Pushkin, 85
References
1. Volkova AR, Fishman MB, Semikova GV. Dynamics of body weight and comorbidities in obese patients after sleeve gastrectomy vs. gastric bypass. Endocrine surgery. 2019;13(4): 175-182. doi: https://doi.org/10.14341/serg10279
2. Bordan NS, Yashkov YI. Evolution ofbiliopancreatic diversion in the treatment of morbid obesity and type 2 diabetes mellitus. Diabetes mellitus. 2017;20(3):201-209. doi: 10.14341/7928
3. Fishman M. B., Karev V. E., Yan V, Sokolova D.A., Mitsinskaya A. I., Mitsinskiy M. A. Metabolic surgery in correction of fatty liver disease. Grekov’s Bulletin of Surgery. 2017;176(1):34-41. (In Russ.) https://doi.org/10.24884/0042-4625-2017-176-1-34-41
4. Liang RJ., Wang HH., Lee WJ. et al. Diagnostic value of ultrasonographic examination for morbidly obese patients undergoing laparoscopic bariatric surgery. Obesity Surgery. 2007. Vol. 17, no.1, pp. 45-56.
5. Ballestri S., Nascimbeni F., Baldelli T. et al. Ultrasonographic fatty liver indicator detects mild steatosis and correlates with metabolic/histological parameters in various liver diseases. Metabolism. 2017 Jul. Vol.72, pp.57-65. doi:10.1016/j.metabol.2017.04.003
6. Ballestri S., Lonardo A., Romagnoli D. et al. Ultrasonographic fatty liver indicator, a novel score which rules out NASH and is correlated with metabolic parameters in NAFLD. Liver Int. 2012 Sept. Vol.32, no8, pp.1242-52. doi:10.1111/j.1478-3231.2012.02804.x
7. Praveenraj P., Gomes R. M., Kumar S. et al. Prevalence and predictors of non-alcoholic fatty liver disease in morbidly obese south Indians patients undergoing bariatric surgery. Obesity Surgery. 2015. Vol.25, no.11, pp.2078-2092.
8. Sedletskii 1.1., Berko O. M., Zlotnikova E. K. Functional-morphological changes in non-alcoholic fatty liver disease after bariatric operations. Grekov’s Bulletin of Surgery. 2019;178(1):82-85. (In Russ.) https://doi.org/10.24884/0042-4625-2019-178-1-82-85
9. Major P., Pedziwiatr M., Rubinkiewicz M. et al. Impact of baritric surgery on non-alcohol fatty liver disease. Pol Przegl Chir. 2017. Vol.89, no.10, pp.1-4.
10. Froylich D., Corcelles R., Daigle C. et al. Effect og Roux-en-Ygastric bypass and sleeve gastectomy on non-alcohol fatty liver disease: a comparative study. Surg Obes Relat Dis. 2016. Vol.12, no.1, pp.127-131.
11. Mathurin P., Hollebecque A., Arnaisteen L. et al. Prospective study og longterm effects of bariatric surgery on liver injury in patients without abvanced disease. Gastroenterology. 2009. Vol.137, no.2, pp.532-540.
12. Singh T., Kochhar G. S., Goh G. B. et al. Safety and efficacy of bariatric surgery in patients with advanced fibrosis. Int J Obes. (Lond.). 2017. Vol.41, no.3, pp.443-449.
Review
For citations:
Kotelnikova L.P., Stepanov R.A., Fedachuk A.N., Grebenkina S.V. Liver steatosis and cholelithiasis in patients with morbid superobesity. Experimental and Clinical Gastroenterology. 2020;(8):45-49. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-180-8-45-49