Ahmed Talha1, Tamer Abdelbaki2, Ayman Farouk3, Ehab Hasouna4, Eman Azzam4, Gihan Shehata5. 1. Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt. ahmedtalha047@yahoo.com. 2. Department of Surgery, Faculty of Medicine, Alexandria University, 165, Horreya Avenue, Hadara, Alexandria, 21561, Egypt. 3. Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt. 4. Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt. 5. Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt.
Abstract
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 eitherlaparoscopic 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.
RCT Entities:
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 obesepatients 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.
Authors: Sylke Haal; Maimoena S S Guman; Sjoerd Bruin; Ruben Schouten; Ruben N van Veen; Paul Fockens; Marcel G W Dijkgraaf; Barbara A Hutten; Victor E A Gerdes; Rogier P Voermans Journal: Obes Surg Date: 2022-02-10 Impact factor: 4.129
Authors: Ignacio Fuente; Axel Beskow; Fernando Wright; Pedro Uad; Martín de Santibañes; Martin Palavecino; Rodrigo Sanchez-Claria; Juan Pekolj; Oscar Mazza Journal: Surg Endosc Date: 2021-01-04 Impact factor: 4.584