Should we prescribe ursodeoxycholic acid after laparoscopic sleeve gastrectomy? A two-center prospective randomized controlled trial

Background In the recent era, laparoscopic sleeve gastrectomy (LSG) had emerged as a safe and effective bariatric procedure. Rapid weight loss is associated with deranged cholesterol metabolism in the form of gallstones. Several studies have shown that ursodeoxycholic acid (UDCA) has a prophylactic role after gastric bypass, vertical banded gastroplasty, and adjustable gastric banding. Yet, data about its effect after LSG are scarce. In this study, we tried to unveil the prophylactic role of UDCA in the prevention of post-LSG gallstones. Materials and methods This two-center prospective randomized controlled trial had been conducted at Abha Private Hospital, Saudi Arabia, and Ain-Shams University hospitals, Egypt, from May 2016 to June 2017 on 89 post-LSG patients. After block randomization, patients were allocated into either group A (UDCA treatment) or group B (control). UDCA was prescribed as 250mg twice daily for 12 months or until the development of gallstones. Results A total of 44 patients were included in group A and 45 patients were included in group B. There was no significant difference between both the groups regarding the baseline parameters. At the sixth month, group A showed a significantly lower incidence of gallstones (6.8 vs. 22.2% in group B; P=0.028). This pattern was maintained till the 12th month (5.8 vs. 14.7%; P=0.031). The overall percentage of gallstones was 23.5% (20/85); it was significantly higher in the first 6 months than in the second 6 months (14.6 vs. 9.7%; P=0.043). Conclusion UDCA is a safe prophylactic measure against gallstones formation and should be integrated into the post-LSG prescription.