Karaciğer sirozunun sleeve gastrektomi sonrası erken postoperatif komplikasyonlara etkisi: eşleştirilmiş vaka-kontrol çalışması

Abstract

Amaç: Obeziteyle ilişkili karaciğer hastalığı, yağlı karaciğer hastalığı (NAFLD) ile başlar ve non-alkolik steatohepatit (NASH) ve siroza ilerleyebilir. Bariatrik cerrahi (BS) etkili bir tedavi yöntemi olmasına rağmen, bazı hastalar bu cerrahiyi ancak karaciğer hasarı geliştikten sonra talep etmektedir. Siroz cerrahi riskini artırsa da, yakın zamanda yayımlanan kılavuzlarda belirtildiği üzere, seçilmiş Child A sınıfı hastalarda potansiyel faydalar risklerden daha ağır basabileceğinden bariatrik cerrahi hala uygulanabilir bir seçenek olabilir. Bu çalışmanın amacı, karaciğer sirozunun bariatrik cerrahi sonrası ilk 30 gün içindeki erken postoperatif komplikasyonlar üzerindeki etkisini değerlendirmektir. Yöntemler: Çalışma, 1:3 oranında eşleştirilmiş, retrospektif bir vaka-kontrol tasarımı kullanılarak gerçekleştirilmiştir. Erken postoperatif komplikasyonlar Clavien-Dindo sınıflaması kullanılarak değerlendirilmiştir. Çalışmaya sirozu olan yedi hasta (vakalar) ve sirozu olmayan 21 hasta (kontroller) dahil edilmiştir. Bulgular: Vaka grubundaki ortalama yaş 52, kontrol grubundakilerde ise 51.1 idi. Ortalama vücut kitle indeksi (VKİ) vakalarda 46.7 kg/m², kontrollerde ise 46.2 kg/m² olup, demografik özellikler açısından anlamlı bir fark bulunmamıştır. Siroz dışı ek hastalıkları değerlendiren Charlson Komorbidite İndeksi (CCI) her iki grupta da 2 idi. Siroz grubunda 3 hastada Grade 1, 1 hastada ise Grade 2 komplikasyon görülürken, kontrol grubunda 2 hastada Grade 1 ve 1 hastada Grade 2 komplikasyon saptanmıştır. Ciddi komplikasyonlar (Clavien-Dindo >IIIa) gözlenmemiş olup, minör komplikasyonlar açısından anlamlı bir fark bulunmamıştır (p<0.05). Sonuç: Child A sınıfı sirotik hastalarda bariatrik cerrahiye kontrendikasyon oluşturacak erken komplikasyonlara rastlanmamıştır. Bu bulgular, benzer vakalarda risk-fayda değerlendirmelerini destekleyebilir ve gelecekteki prospektif çalışmalara rehberlik edebilir.

Keywords

• siroz
• sleeve gastrektomi
• komplikasyon
• bariatrik cerrahi

The effect of liver cirrhosis on early postoperative complications after sleeve gastrectomy: a matched case-control study

Abstract

Aims: Obesity-related liver disease begins with non-alcoholic fatty liver disease (NAFLD) and may progress to non-alcoholic steatohepatitis (NASH) and cirrhosis. Sleeve gastrectomy (SG) is an effective treatment, though some patients only seek it after liver damage has occurred. While cirrhosis increases surgical risk, SG may still be viable for selected child A patients, with potential benefits outweighing the risks, as noted in recent guidelines. This study aims to evaluate the impact of liver cirrhosis on first 30-day postoperative complications following SG. Methods: A 1:3 retrospective matched case-control design was used. Early postoperative complications were assessed using the Clavien-Dindo classification. Seven patients with cirrhosis (cases) and 21 without (controls) were included. Results: The median age was 51 (44-62) in the case group and 51 (44-61) in controls. Median body-mass index (BMI) was 45.7 kg/m2 (39.9-48.4) for cases and 44.7 kg/m2 (40.3-47) for controls, with no significant demographic differences. Excluding the 3-points for cirrhosis, the median Charlson Comorbidity Index (CCI) for other comorbidities was 2 in both groups. In the cirrhotic group, 3 had CDC grade 1 and 1 had grade 2 complications; in the control group, 2 had grade 1 and 1 had grade 2. No severe complications (Clavien-Dindo >IIIa) occurred, and there was no significant difference in minor complications (p<0.05). Conclusion: No early complications were observed that would contraindicate SG in child A cirrhotic patients. These findings may support risk-benefit evaluations in similar cases and guide future prospective studies.

Keywords

• Cirrhosis
• sleeve gastrectomy
• obesity
• complication
• bariatric surgery

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