Management of Nutritional and Metabolic Complications of Bariatric Surgery: Hepatic Complications After Bariatric Surgery

Although jejunoileal bypass has been abandoned due to the high rate of hepatic complications, cases of hepatic complications of current bariatric procedures are still reported. Even though weight loss after bariatric surgery frequently induces an improvement of non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, and fibrosis, bariatric procedures have been also associated with cases of acute liver failure or of chronic liver disease evolving until cirrhosis. The clinical manifestations of hepatic complications after bariatric surgery vary from elevated liver enzymes, hypoproteinemia, and hyperammonemia to liver failure. Possible underlying mechanisms include (1) rapid and drastic weight loss, (2) protein–calorie malnutrition, (3) gut microbiota alteration and bacterial overgrowth, and (4) pre-existing chronic hepatic diseases. Although the incidence is low, bariatric surgeons should be alert to this catastrophic complication, recognize high-risk patients, select appropriate procedures, and follow the patients carefully including early diagnosis and appropriate treatment.