Bariatric surgery is a surgical procedure for long term weight loss for the morbidly obese group of people. Many of these individuals have fatty liver disease at the time of surgery and some may have signs of gross liver damage. Fatty liver is a natural accompaniment of obesity and occurs because of excess fat deposition within the liver.
This causes the liver to become larger and heavier and sometimes there is inflammation because of the fat which is called as fatty liver hepatitis. This condition can be detected by simple blood tests (LFTs) and ultrasound scan of the liver. In cases where the liver damage is more, doctors may advise the person to undergo a fibroscan which gives a detailed assessment of the liver.
Immediately prior to bariatric surgery, the patient is kept on a liquid very low calorie diet for 5-7 days. This itself helps to decrease the fat deposits within the liver and decreases the liver size which in turn makes it easier for the surgeon to manipulate during the surgery. After surgery, there is a gradual and sustained weight loss which helps to decrease both the subcutaneous as well as the visceral fat from the body.
Bariatric surgery reverses many of the changes present in the liver due to obesity. Biopsies of the liver before and sometime after the surgery have shown marked improvement in liver structure and function. Liver size and weight often returns to normal within a few months of surgery and the inflammation within the liver also subsides. In patients with gross damage to the liver prior to the surgery, the chances of liver failure are decreased markedly. In many cases, bariatric surgery averts the patients from undergoing a liver transplant later in life.