TACTICAL MANAGEMENT OF UNEXPECTED CIRRHOSIS IN BARIATRIC SURGERY

Abstract

This retrospective analysis of 629 consecutive laparoscopic bariatric surgery patients (2023-2024) evaluated management strategies for incidentally discovered liver cirrhosis. Despite standard preoperative screening, 39 patients (6.2%) presented with unexpected intraoperative cirrhosis confirmed by biopsy. Surgical modification was required in 30.8% of cases, including procedure conversions and abandonment. While 69.2% proceeded with technical modifications, complications occurred in 10.2% with one mortality (2.5%). Twelve-month follow-up revealed significant improvements in liver stiffness (18.7 to 12.3 kPa, p<0.001), reduced hepatic steatosis (81%), and improved Child-Pugh scores (79.5%). These findings emphasize the need for institutional protocols and decision algorithms for managing unexpected cirrhosis during bariatric surgery.