Management of gallstone disease prior to and after metabolic surgery: a single-center observational study
| Autor: | Romano Schneider, Marko Kraljević, Amanda S. Dirnberger, Marc Slawik, Ralph Peterli, Bettina K. Wölnerhanssen, Katja Linke |
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| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
business.industry Gallbladder Gallbladder disease Gastric Bypass Bariatric Surgery Gallstones Perioperative medicine.disease Single Center Obesity Morbid Surgery Postoperative Complications medicine.anatomical_structure Gastrectomy Concomitant Humans Medicine Laparoscopy Risk factor business Complication Retrospective Studies |
| Zdroj: | Surgery for Obesity and Related Diseases. 18:182-188 |
| ISSN: | 1550-7289 |
| DOI: | 10.1016/j.soard.2021.10.006 |
| Popis: | Background Rapid weight loss after bariatric surgery is a risk factor for gallstone formation. There are different strategies regarding its management in bariatric patients, including prophylactic cholecystectomy (CCE) in all patients, concomitant CCE only in symptomatic patients, or concomitant CCE in all patients with known gallstones. We present the safety and long-term results of the last concept. Method Retrospective single-center analysis of a prospective database on perioperative and long-term results of patients with laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) over a 15-year period. The minimal follow-up was 24 months. Concomitant CCE was intended for all patients with gallstones detected by preoperative sonography. Setting Academic teaching hospital in Switzerland. Results After exclusion of patients with a history of CCE (11.5%), a total of 1174 patients (69.6% LRYGB, 30.4% LSG) were included in the final analysis. Preoperative gallbladder pathology was detected in 21.2% of patients, of whom 98.4%, or 20.9% of the total patients, received a concomitant CCE. The additional procedure prolonged the average operation time by 38 minutes (not significant) and did not increase the complication rate compared with bariatric procedure without CCE (3.7% versus 5.7%, P = .26). No complication was directly linked to the CCE. Postoperative symptomatic gallbladder disease was observed in 9.3% of patients (LRYGB 7.0% versus LSG 2.3%, P = .15), with 19.8% of those patients initially presenting with a complication. Conclusion The concept of concomitant CCE in primary bariatric patients with gallstones was feasible and safe. Nevertheless, 9.3% of primary gallstone-free patients developed postoperative symptomatic gallbladder disease and required subsequent CCE despite routine ursodeoxycholic acid prophylaxis. |
| Databáze: | OpenAIRE |
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