{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:34:07Z","timestamp":1787762047096,"version":"build-2784847793"},"reference-count":5,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T00:00:00Z","timestamp":1741132800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The increasing prevalence of obesity has made managing metabolic-dysfunction-associated steatotic liver disease and metabolic-dysfunction-associated steatohepatitis (MASH) with cirrhosis a significant challenge. This report details the case of a 53-year-old woman with class-V obesity (body mass index: 63.9 kg\/m\u00b2) and MASH-associated decompensated cirrhosis with portal hypertension who underwent robotic sleeve gastrectomy (SG) after preoperative optimisation. Initial management involved stabilisation of variceal bleeding, a very-low-calorie diet, beta-blockers and continuous positive airway pressure, leading to improved liver function and Child\u2013Turcotte\u2013Pugh class improvement from B to A. The robotic SG, performed with meticulous intraoperative techniques to minimise bleeding and good post-operative care, resulted in favourable outcomes, including significant weight loss (44.8% total body weight loss) and improved liver parameters at 18-months. This case highlights the feasibility of metabolic and bariatric surgery in carefully selected cirrhotic patients following comprehensive optimisation and multidisciplinary care.<\/jats:p>","DOI":"10.4103\/jmas.jmas_297_24","type":"journal-article","created":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T04:00:24Z","timestamp":1741233624000},"page":"417-419","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Robotic sleeve gastrectomy in a woman with class V obesity, cirrhosis and portal hypertension: A step forward"],"prefix":"10.4103","volume":"21","author":[{"given":"Lokesh","family":"Agarwal","sequence":"first","affiliation":[{"name":"Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaibhav Kumar","family":"Varshney","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Selvakumar","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subhash Chandra","family":"Soni","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peeyush","family":"Varshney","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayushi","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,3,5]]},"reference":[{"key":"R1-20251014","doi-asserted-by":"crossref","first-page":"197","DOI":"10.7570\/jomes23052","article-title":"Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD):A state-of-the-art review","volume":"32","author":"Chan","year":"2023","journal-title":"J Obes Metab Syndr"},{"key":"R2-20251014","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1080\/17474124.2021.1902803","article-title":"The clinical impact of cirrhosis on the postoperative outcomes of patients undergoing bariatric surgery:Propensity score-matched analysis of 2011-2017 US hospitals","volume":"15","author":"Lee","year":"2021","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"R3-20251014","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1038\/s41575-023-00846-4","article-title":"Recompensation in cirrhosis:Unravelling the evolving natural history of nonalcoholic fatty liver disease","volume":"21","author":"Feng","year":"2024","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"R4-20251014","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1007\/s11695-015-1727-2","article-title":"A systematic review of bariatric surgery in patients with liver cirrhosis","volume":"25","author":"Jan","year":"2015","journal-title":"Obes Surg"},{"key":"R5-20251014","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.jceh.2022.08.002","article-title":"Recompensation in cirrhosis:Current evidence and future directions","volume":"13","author":"Sharma","year":"2023","journal-title":"J Clin Exp Hepatol"}],"container-title":["Journal of Minimal Access Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jmas.jmas_297_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:14:05Z","timestamp":1787760845000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jmas.jmas_297_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,5]]},"references-count":5,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/jmas.jmas_297_24","relation":{},"ISSN":["0972-9941","1998-3921"],"issn-type":[{"value":"0972-9941","type":"print"},{"value":"1998-3921","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,5]]},"assertion":[{"value":"2024-10-08","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-13","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}