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If you’re living with a condition known as fatty liver, it may be time to consider bariatric surgery as an option towards losing weight and reducing fatty deposits from the liver.
Bariatric surgery is also sometimes referred to as weight-loss surgery, but that’s not the only reason why bariatric surgery is done, according to Michel Murr, MD. “The more important benefits of bariatric surgery are the improvements of general health and quality of life,” he says, specifically those with the following conditions can see dramatic improvement after weight loss, to the point of not requiring medications:
- Fatty liver
- Sleep apnea
- Degenerative joint disease
Common Types of Bariatric Surgery
The most common bariatric operations are gastric bypass and gastric sleeve (or sleeve gastrectomy). Both of these procedures can be performed laparoscopically or robotically through small incisions, reducing pain and minimizing recovery time after surgery.
With gastric bypass surgery, a small pouch is created from the top portion of the stomach, which is then connected directly to the small intestine. Ingested food that goes into the esophagus and the pouch and then goes into the small intestine and bypasses the stomach (that’s why this is called gastric bypass!). This operation not only reduces the amount of food that can be ingested but it also has a profound impact on how the body metabolizes foods and carbohydrates.
With a gastric sleeve procedure, the stomach is divided into two compartments and the larger compartment is removed. The stomach pouch that remains is the shape and size of a small banana and is no longer capable of storing large portions of food. The effects of gastric sleeve on metabolism are less obvious than in gastric bypass.
According to Dr. Murr, “We have perfected doing these operations with minimally invasive techniques (laparoscopic or robotic) which reduces post-surgery pain and the length of hospital stay.” Additionally, at AdventHealth Tampa we utilize opioid-free anesthesia, nerve blocks and non-narcotic pain medications to enhance recovery. Generally speaking, most patients leave the hospital one day after gastric sleeve and one and a half days after gastric bypass.
Once a patient is back home, it takes seven to 10 days to return to a full schedule of daily activities at home, and generally the patient can be back to full-time work within four weeks. During recovery time, Dr. Murr says it’s important for the patient to “adjust to new eating habits and focus on their wellbeing.”
Some people may be concerned about the risks or side effects of bariatric surgery, but Dr. Murr explains that these types of operations are typically associated with a very low risk of death and complications — such as bleeding ulcers and bowel obstruction. According to the American Society of Metabolic and Bariatric Surgery, the risk of death following this surgery averages 0.13%, which Dr. Murr says is “considerably less than most other operations, including gall bladder and hip replacement surgery.”
Who Is a Candidate for Bariatric Surgery?
If you have a body mass index (BMI) greater than 40 kg/m2 (approximately 100 pounds overweight), you may be a candidate for bariatric surgery. Patients with a BMI of 35-39 kg/m2 and a major medical condition such as diabetes, hypertension, or sleep apnea are also candidates for surgery.
You’re never too old to be considered for bariatric surgery, and at AdventHealth we consider young adults as early as 16 years of age as candidates for surgery, provided a high level of maturity, Dr. Murr advises.
Reversing Fatty Liver Obesity is associated with the accumulation of fat into the liver, which is a condition known as fatty liver. Fatty deposition not only enlarges the size of the liver, it contributes to diabetes by increasing insulin resistance in the liver itself.
As patients lose weight after bariatric surgery, fatty deposits in the liver are reduced, improving insulin sensitivity and correcting diabetes.
More importantly, Dr. Murr explains, “fat deposition in the liver for a long time induces chronic inflammation and liver cell damage and invites deposition of scar tissue in the liver and fibrosis, commonly known as cirrhosis. Patients who develop cirrhosis have a short life expectancy because of worsening liver function and liver failure.”
Bariatric surgery is very effective in reducing fatty deposits from the liver and reducing inflammation in 95% of patients, says Dr. Murr. Bariatric surgery also halts the position of scar tissue in the liver and reverses fibrosis in 55% of patients, according to a recent study by Dr. Murr and his colleagues.
Dangers of Living With Fatty Liver
“At least 75 million Americans have fatty liver and about 5% of people with fatty liver will progress to cirrhosis and may require a liver transplant,” Dr. Murr says, adding, “Once inflammation is set in the liver from chronic fat deposition, 20% of those patients may progress to cirrhosis.”
The first medical treatment for fatty liver will include a diet and lifestyle modification, as well as vitamin-E supplements. However, in patients with obesity, diet and lifestyle modification are effective in just a small number of patients. Dr. Murr feels that bariatric surgery offers durable and sustainable weight loss and effective reversal of fatty liver, in addition to improving other health conditions.
“We’re leading the way in clinical and basic science research to understand how bariatric surgery reverses liver damage and to find newer medications for fatty liver,” Dr. Murr says.