[Original Article] Risk factors for perioperative liver damage in laparoscopic sleeve gastrectomy for morbid obesity

[ABSTRACT]【Background】The association of liver dysfunction with morbid obesity has been speculated, which can be improved to some extent by metabolic surgery as represented by laparoscopic sleeve gastrectomy (LSG). However, the postoperative liver damage due to surgical procedures can sometimes be serious. Therefore, understanding the risk of perioperative liver damage and the positive effects of LSG on liver function is necessary. 【Materials and methods】A total of 46 morbid obesity cases that underwent LSG at Chiba University Hospital between 2010 and 2021 were evaluated for patient background, surgical factors, liver function and liver damage course and analyzed for perioperative liver damage risk factors. 【Results】The liver to spleen ratio (LS ratio) in plain computed tomography (CT), an index that reflects liver fattening, significantly reduced 1 year after LSG compared to baseline values (P < 0.0001), but without improvement in Fib-4 index, an indicator of liver fibrosis (P = 0.28). Liver damage (≧ CTCAE grade2) was observed in 28.3% (13/46) of patients 3 days after surgery, with one patient requiring a platelet transfusion. The risk factors of perioperative liver damage include high Fib-4 index (P = 0.016), high visceral fat subcutaneous fat ratio (VS ratio)(P = 0.049), and long surgical duration (P = 0.023) using the multivariate logistic regression analysis.【Conclusions】Avoiding perioperative liver damage to perform appropriate preoperative evaluation, including blood and imaging tests, and aiming to shorten the surgical duration is important for patients with morbid obesity undergoing LSG. LSG for morbid obesity shows hepatic fattening improvement with weight loss, but the effect on liver fibrosis should be examined including a longer course.