Cholelithiasis after bariatric surgery, incidence, and prophylaxis: randomized controlled trial

被引:41
作者
Talha, Ahmed [1 ]
Abdelbaki, Tamer [2 ]
Farouk, Ayman [1 ]
Hasouna, Ehab [3 ]
Azzam, Eman [3 ]
Shehata, Gihan [4 ]
机构
[1] Alexandria Univ, Med Res Inst, Dept Surg, Alexandria, Egypt
[2] Alexandria Univ, Fac Med, Dept Surg, 165 Horreya Ave, Alexandria 21561, Egypt
[3] Alexandria Univ, Fac Med, Dept Internal Med, Alexandria, Egypt
[4] Alexandria Univ, Med Res Inst, Dept Biomed Informat & Med Stat, Alexandria, Egypt
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2020年 / 34卷 / 12期
关键词
Obesity; Gallstones; Bariatric surgery; Ursodeoxycholic acid; GASTRIC BYPASS-SURGERY; RAPID WEIGHT-LOSS; GALLSTONE FORMATION; OBESE-PATIENTS; RESTRICTIVE PROCEDURES; MORBID-OBESITY; RISK-FACTORS; DOUBLE-BLIND; GALLBLADDER; CHOLECYSTECTOMY;
D O I
10.1007/s00464-019-07323-7
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background Rapid weight loss is associated with a high incidence of cholelithiasis. Objectives To identify the incidence of gallstone formation after weight loss surgery and to detect the efficacy of 6 months regimen of prophylactic Ursodeoxycholic acid (UDCA). Methods RCT included a total of 1530 morbid obese patients who were subjected to either laparoscopic one anastomosis gastric bypass (OAGB), sleeve gastrectomy (SG), or greater curve plication (GCP). Patients with previous or concomitant cholecystectomy and missed follow-up were excluded, leaving 1432 patients to analyze. They were randomly allocated into two groups receiving either UDCA or placebo with a minimum follow-up of one year for assessment of cholelithiasis and weight loss. Results The overall incidence of cholelithiasis after surgery was 9.7%. There was a significant decrease in the incidence of gallstone formation from 22% in placebo to 6.5% in treated group with UDCA. The mean percentage of excess weight loss (%EWL) was significantly higher in those who develop gallstones than others. Of those developing gallstones, there was 64.7 % with SG versus 28.1% and 7.2% in OAGB and GCP, respectively, which is statistically significant. NNT to prevent cholelithiasis is six, AR% is 70.4%, and RR is 3.4%. Conclusions Cholelithiasis after SG and OAGB was higher than GCP. %EWL was rapid and higher in OAGB and SG contributing to the higher rate of symptomatic cholelithiasis and could be predictive for post-bariatric cholelithiasis. A 6-month use of UDCA is an effective prophylaxis decreasing gallstone formation after bariatric surgery at short-term follow-up.
引用
收藏
页码:5331 / 5337
页数:7
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