BARIATRIC SURGERY AND FATTY LIVER DISEASE IN PATIENTS WITH OBESITY AND METABOLIC SYNDROME: EFFECT ON STEATOSIS AND FIBROSIS, RISKS, AND PREVENTION OF CIRRHOSIS (A LITERATURE REVIEW)

Abstract

Fatty liver disease associated with metabolic dysfunction accompanies most cases of obesity and metabolic syndrome and in a proportion of patients progresses to cirrhosis. This narrative review summarises evidence on the effect of bariatric surgery on hepatic steatosis, steatohepatitis and fibrosis, on its limitations and risks, and on approaches to the prevention of cirrhosis after surgery. Publications from PubMed, Google Scholar and SciSpace, mainly from 2015–2026, were analysed. Bariatric surgery resolves steatohepatitis in about 84% of patients at five years and reduces the ten-year incidence of major adverse liver outcomes from 9.6% to 2.3%; in a randomised trial, steatohepatitis resolved in 56–57% of operated patients versus 16% with lifestyle intervention. Regression of fibrosis is less frequent (25–70%), advanced fibrosis persists in nearly half of the patients who had it at baseline, and new or worsening liver lesions occur in about 12%. Liver enzymes normalise in most but not all patients. Rapid weight loss, malnutrition, alcohol use and pre-existing cirrhosis are the main sources of risk. Recommendations on liver follow-up after surgery are based on expert opinion, and no data are available for Central Asian populations. Studies combining routine clinical and laboratory data with an assessment of patients’ lifestyle and adherence are needed.