Table 2.

A comparison of the benefits and risks of bariatric surgery techniques for patients with cirrhosis.

Techniques	Pro	Cons	Reference
Sleeve gastrectomy (SG)	Mechanical and hormonal weight loss. No interference with corticosteroid pharmacokinetics. Easier access in the event of gastric variceal bleeding. Maintains access to the biliary system.	Development of Gastroesophageal Reflux Disease (GERD).	Mittal et al., 2021 [220]
Laparoscopic adjustable gastric banding (LAGB)	Lower early complications and shorter operative time and length of stay.	Interference with corticosteroid pharmacokinetics. Not the most effective surgical procedure to reducing weight.	Tichansky et al., 2005 [221]
Roux-en-Y gastric bypass (RYGB)	Reduction of reflux gastritis and esophagitis. It improved glycemic control and high-density lipoprotein levels.	No access to the biliary system. Possible development of a stomal ulcer. Increased probability of cholelithiasis and Roux stasis syndrome. Interference with corticosteroid pharmacokinetics.	Tichansky et al., 2005 [221]
Intragastric balloon (IGB)	Non-invasive and rapid procedure. Rapid weight loss.	Upper gastrointestinal bleeding. Increase in liver fat fraction. Rapid weight loss. Not durable.	Watt et al., 2021 [223]
Timing	Pro	Cons	Reference
Before LT	Resolution of obesity-related comorbidities.	Increased costs. Two different hospitalisations. Increased patient discomfort and delayed LT. Worsening sarcopenia and malnourishment of the patient.	Diwan et al., 2018 [225]
During LT	Resolution of obesity-related comorbidities. Costs and patient discomfort are minimised.	The complexity of the procedure.	Tariciotti et al., 2016 [228]
After LT	Decrease in obesity-related comorbidities after LT.	Increased susceptibility to infections. Poor wound healing. Hostile abdominal environment after LT.	Lin et al., 2013 [232]