Surgery is not the first-line treatment option for patients with non- Alcoholic fatty liver disease (NAFLD). However, gastric bypass surgery is recommended in patients with non-alcoholic fatty liver disease whose BMI is greater than 35 particularly in those without improvement in imaging-detected hepatic steatosis or fibrosis after behavioral modification or medication therapy.

• Patients with NAFLD and BMI greater than 35 who psychologically stable^[1]
• In patients who failed medical therapy.

• The most common procedures are adjustable gastric banding and the Roux-en-Y bypass.^[2]
• A Y-shaped section of the i bum is attached to the pouch so that food bypasses the duodenum and proximal section of the jejunum.
• A laparoscopic sleeve gastrectomy may be a secure and powerful treatment of weight problems in adult patients. Significant and sustained weight reduction results in the improvement NAFLD.^[3][4]

• The size of the stomach is reduced either by stapling or banding, creating a small pouch, assisting with weight loss by inducing
  • Earlier satiety
  • Reducing caloric intake
  • Decreasing absorptive capacity
• The feasibility of liver transplantation depends on the stage of NAFLD at diagnosis.NAFLD is emerging as the second most common cause for liver transplant.^[5][6]
  • Indication 1 End stage liver-disease 
  • Indication 2 Hepatocellular carcinoma (HCC) are the two most important indications for the liver transplant.
  • Outcome : After liver transplanation patients with or without NASH may survive 1,3 and 5 years and are increasinly at risk for cardio vascular risks.^[7]

• Early complications include:
  • Peritonitis
  • Pulmonary embolism
• Late complications include
  • Nutritional deficiencies
  • Iron deficiency anemia
  • Dumping syndrome
  • Ulcers