Alabama Bariatrics & Minimally Invasive Surgery

Bariatric Diet Orbera Gastric Band Sleeve Gastrectomy Gastric Bypass

W. Jay Suggs, MD, FACS, FASMBS
Madison, Huntsville, and Decatur
Phone: (256) 274-4523
Fax: (256) 203-8791

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Weight Loss Surgeries and Liver Transplants, should they be Connected?

People forget sometimes how interconnected we are to the rest of the world. Whatever decision we make, whether we realize it or not, effects the environment around us either to the benefit or detriment of our immediate environment. And it often doesn’t come from a malicious or willingly conscious place. We are so good at compartmentalizing and categorizing things that we just forget that everything in the world has cause and effect. 

So, I was both surprised and mortified to find out that there were even more ways that morbid obesity can affect your body. Specifically, your liver.

Obesity and Liver Disease

 

It is well known among the general populace that liver disease can come from the consumption of too much alcohol. Heck, in popular media we even joke about getting so drunk that we kill our livers on St Patrick’s Day. However, there has been a rise in liver disease among nondrinkers, mainly from those who are either obese or are suffering from type 2 diabetes.

This condition is known as NAFLD or Nonalcoholic fatty liver disease, and it is exactly as it sounds. Fat gets deposited in the liver, decreasing its functionality over time if it increases in severity. It has been estimated to currently effect 20-30 percent of the American population. That is 97 million Americans.

And that doesn’t even touch the statistics of morbidly obese patients. According to doctors Clain and Lefkowitch, medical professionals that contributed publications regarding liver pathology, About 90 per cent of morbidly obese patients show histological abnormalities of the liver.” Do you know how long ago that publication was released? 1987. We have known for 31 years that morbid obesity causes liver damage.

What makes it even more terrifying is that for the most part, people aren’t aware that they even have it. There are no visible symptoms as it progresses, because nothing is visible short term. However, if it goes on long enough it can cause a condition known as cirrhosis. When someone undergoes cirrhosis, fluid builds up in the abdomen, your veins swell in your esophagus, you suffer delirium, go through liver cancer, and suffer end stage liver failure.

No one survives end stage liver failure. And the sad truth is that statistically,20% of morbidly obese people die from that condition.

However, there is hope for the morbidly obese who are willing to make changes to their lives and ask for the help they need.

Combining Liver Transplantation and Weight Loss Surgery

A publication was recently released in Hepatology by Julie K. Heimbach, M.D , a transplant surgeon who studied the correlation between obesity and fatty liver disease. The study included 49 adults with morbid obesity, 29 of which who were unable to lose the sufficient amount of weigh before their liver transplant procedure.  Instead of turning them away for not fitting the qualifications, the doctors involved with the study performed a joint procedure of both a liver transplant and a common weight loss surgery a sleeve gastrectomy.

The results were astounding to say the least.

“Three years after surgery, patients who had the liver transplant alone maintained a weight loss of a median of 3.9 percent of their total body weight compared to 34.8 percent for patients who had the transplant and weight-loss surgery.”

These patients, who couldn’t lose weight before their procedure managed to keep of 10 times more the weight because of a liver transplant.

“In addition, those patients who had the dual surgery were less likely to have high blood pressure, insulin resistance and fatty liver. They needed less medication to lower blood pressure and cholesterol.”

According to this recent article, the statement made by the doctor in charge of the study, “Even though most obese people will not need a transplant, for those who develop advanced liver disease, we need to have an approach that treats not only the liver disease but the cause of the liver disease”.

The Implications of Weight Loss Surgery and Obesity as We Know It

This study raises a lot of questions about what doctors, laymen, and society understand the medical field as we know it.  For instance, my first question, once I found out about this experiment, was, “Do all doctors look at medicine with such an interdependent approach? “

When an average person looks at a body part, they only see it as its initial independent classification, what it is, and how it functions. But do we really examine its relationship to the surrounding organs and how they work together to achieve functionality?  What if we all lacked an initial understanding of obesity this whole time, because we were so busy focusing on one area, the stomach?

Maybe the answer to the obesity crisis, and the next step for weight loss surgery is a better understanding of how it impacts the surrounding organs, and not just the stomach. Either way, it is a fascinating testament to what we can achieve if we simply look at something from a different point of view.

Alabama Bariatrics