The Impact of Combined Bariatric Interventions on the Course of Non-Alcoholic Fatty Liver Disease
Authors: Mitsinskaya Aleksandra Igorevna , Evdoshenko Vladimir Viktorovich , Fishman Mikhail Borisovich , Sokolov Alexey Yurievich , Samoilov V. Sergeevich , Mitsinskiy Mikhail Alekseevich , Varzin Sergey Alexandrovich , Akhmetov Azat Danisovich 
Published: July 2021

Background. Obesity is widely recognized as a disease that acquires the scale of an epidemic and is accompanied by a number of comorbidities, one of which is non-alcoholic fatty liver disease (NAFLD), while the issue of the impact of bariatric interventions on its course remains a subject of discussion, which determines the relevance of this study.Aims. Тo evaluate the impact of combined bariatric interventions - laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic mini-gastric bypass (LMGB-OAGB), - on the course of NAFLD and to determine the criteria that affect the dynamics of NAFLD after thеsе bariatric interventions.Materials and methods. The study included 56 patients who had one of 2 types of bariatric interventions performed between 2014 and 2017: LRYGB (26 (46,4%) patients) and LMGB-OAGB (30 (53,6%) patients). All patients underwent intraoperative liver biopsy, a range of laboratory and instrumental studies, FibroTest were calculated in dynamics. The frequency of complications in the postoperative period was estimated. The period of observation was 2 years. Results. In the group of laparoscopic Roux-en-Y gastric bypass 12 (46.2%) patients showed signs of liver fibrosis according to histological research, and 8 (30.8%) - signs of non - alcoholic steatohepatitis (NASH). There was an increase in transaminases in 5(19,2%), gamma-glutamyltranspeptidase (GGTP) in 19 (73.1%), and total bilirubin in 8 (30.8%) subjects. 20 (76.9%) participants had increased alkaline phosphatase (ALP), 22 (84.6%) had reduced high density lipoproteins (HDL) and increased triglycerides (TG). According to the results of ultrasound examination of the liver, 19 (73.1%) patients had enlarged liver size, 26 (100%) - diffuse heterogeneity, and 25 (96.2%) - hyperechogenicity. In the group of laparoscopic mini-gastric bypass, there were signs of liver fibrosis in 14 (46.7%) and NASH - in 14 (46.7%) patients. An increase in tranasminases was observed in 8 (26.7%), GGTP in 22 (73.3%), and total bilirubin in 6 (20%) patients. 9 (30%) of participants had increased ALP, 26 (86.7%) patients had reduced HDL and increased TG. 21 (70%) patients had enlarged liver size, 29 (96.7%) - diffuse heterogeneity, and 28 (93.3%) - hyperechogenicity.6 months after both types of interventions, there was a decrease in the clinical and biochemical characteristics of non-alcoholic fatty liver disease, which was transient and regressed by 1 year after surgery.After laparoscopic Roux-en-Y gastric bypass %EBMIL in 1 year was 75.25 [65.85-84.36] %. Normalization of transaminases was observed in 84.6%, cholestasis indicators in 87.2%, and FibroTest -in 46.2% of cases. % EBMIL 1 year after laparoscopic mini-gastric bypass was 74.77 [67.28-78.89] %. Normalization of transaminases was observed in 83.3%, cholestasis indicators in 78.9%, and FibroTest -in 43.3% of cases.Combined bariatric interventions were shown to be more effective in participants under 45 years of age compared to those over 45 years of age and in patients with initial stages of fibrosis F0-F2 by METAVIR compared to participants with stages F3-F4 by METAVIR. Patients with a BMI of more than 40 kg / m2 achieved higher FibroTest values after six months compared to subjects with a BMI of up to 40 kg/m2 and in fewer cases - FibroTest normalization by 1 year after surgery, respectively. The effectiveness of operations on the course of NAFLD was comparable.The results of the intervention on signs of non-alcoholic fatty liver disease were preserved for 2 years of postoperative follow-up. The mortality rate during the entire follow-up period was 0%. 47 (83,9%) patients were followed up to 2 years.Conclusion. Тhere was a high efficiency of RYGB and MGB-OAGB in patients with non-alcoholic fatty liver disease, while a transient aggravation of the course of non-alcoholic fatty liver disease was detected 6 months after the operation.Keywords: non-alcoholic fatty liver disease; obesity; metabolic syndrome; bariatric surgery; LRYGB; LMGB-OAGB; FibroTest; surgical intervention