Outcomes of bariatric surgery in the setting of advanced compensated chronic liver disease associated with clinically significant portal hypertension: a multicenter, international feasibility and safety study ; Résultats de la chirurgie bariatrique dans le contexte d'une maladie hépatique chronique avancée compensée associée à une hypertension portale cliniquement significative : une étude multicentrique et internationale sur la faisabilité et la sécurité

The global obesity epidemic has led to an increase in the proportion of patients with chronic liver disease due to non-alcoholic fatty liver disease (NAFLD), and in the prevalence of obesity in patients with cirrhosis of all etiologies. The reported prevalence of obesity in patients with cirrhosis is 30%, which appears similar to that of the general population . Bariatric surgery (BC) is currently considered the most effective and long-lasting treatment for morbid obesity, as it is associated not only with remission and/or improvement of many obesity-related comorbidities, but also with improved quality of life and lifespan for obese patients . However, the surgical risk of bariatric surgery is higher in patients with liver cirrhosis than in those without, and determining the benefit-risk ratio of surgery in this context is a complex task, especially as there are currently no randomized controlled trials on the subject . Mosko et al. reported a threefold higher mortality rate for bariatric surgery in patients with compensated cirrhosis compared with those without cirrhosis (0.9% vs. 0.3%) in a in a national study of hospitalizations in the USA between 1998 and 2007 (4). Interestingly, the authors also showed that mortality was significantly higher in cases of decompensated cirrhosis (16.3%), clearly identified as a contraindication to bariatric surgery. However, this study was published over ten years ago, and the mortality of bariatric surgery has decreased considerably and is currently around 0.1%. Furthermore, among patients with morbid obesity and compensated advanced chronic liver disease (cACLD) (currently synonymous with the term "compensated cirrhosis"), some may also present with clinically significant portal hypertension (CSPH), representing a subgroup of patients requiring special management. The concept of clinically significant portal hypertension (CSPH) defined at the Baveno VI consensus conference plays a major role in Baveno VII, and is defined by the presence of a porto-caval gradient ≥ 10 mmHg ...