Long-term fulminant hepatic failure in patients undergoing gastric bypass for morbid obesity

Abstract

Morbid obesity is a risk factor for numerous diseases including liver disease with an incidence of hepatic steatosis from 70 to 80%. Although surgical treatment is effective in reducing weight, its effects on the liver have not been established convincingly. We report 2 cases of patients with bariatric surgery and who had a fulminant hepatic failure resulting in death. Methods: case N.° 1: a 36-year-obesity intervened in 1995 with VBG with BMI 52.5 to reganancia weight back after revision surgery is performed in 2009 performed distal gastric bypass. Case N.° 2: 42 Woman surgery for obesity in 2009 by distal gastric bypass with a BMI of 51 and placement of prophylactic Composix kugel midline mesh. After 3 years with good weight loss, presents abscess wall and enterocutaneous fistula he was surgically intervene. extracting mesh, identifying themselves two fistulas in alimentary and common intestinals loops that are removed and new anastomosis was performed. Results: case N.° 1: at 2 months of revision surgery, tje patient starts vomiting secondary to stenosis of gastrojejunostomy anastomosis and symptoms of progressive jaundice, ascites and encephalopathy fulminant hepatic failure resulting in death. Case N.° 2: in the immediate postoperative period starts increased drainage of debit and rise of liver enzymes cytolysis and coagulopathy. It reinterviene on suspicion of anastomotic leak and abdominal Sepsis, developing fulminant hepatic failure with coagulopathy and encephalopathy is treated by MARS system, and died within 4 hours of the onset of therapy. Conclusions: although current surgical techniques of bariatric surgery are considered quite safe, there have been cases of hepatic failure, unclear whether this would relate to the progression of a preexisting steatohepatitis, or may have other predisposing factors related to surgery. Treatments available, the emergency orthotopic liver transplantation is one of the best interventions. For our patients the outcome was fatal triggering the death of both. In both cases presented a septic shock with positive ascitic fluid cultures to multiresistant microorganisms, and both had revision surgery. Unfortunately the factors that can influence that occur after bariatric surgery such complications, and probably will be grounds for future studies are unknown.