Intraoperative ultrasound and prophylactic ursodiol for gallstone prevention following laparoscopic gastric bypass

Abstract

IOUS during LRYGB efficiently screens for gallstones, and selective cholecystectomy followed by prophylactic ursodiol results in low morbidity. Improvements in compliance may lower the incidence of postoperative gallstone formation.

Predictors of Gallstone Formation in Morbidly Obese Patients after Bariatric Surgery: A Retrospective Observational Study

“…In this study the prevalence of cholelithiasis was 25.9% which is similar to that reported in other studies [22][23][24][25]. The literature reported values between 13.6% and 47.9% [7,14,15,18,22,26]. The high prevalence of cholelithiasis in …”

“…The mean time for gallstone formation in our study was 13.2 months coinciding with the period of rapid weight loss as it was reported in many published series [14-16, 24,30]. This pattern of incidence (higher in the phase of greater weight loss) has motivated several surgeons to use ursodeoxycholic acid in the first 6 postoperative months [14][15][16]. This drug is a bile acid that prevents biliary lithiasis by decreasing cholesterol and mucin concentration, increasing bile acid concentration, decreasing bile saturation, and enhancing gallbladder emptying [16,33].…”

“…Additionally, it has been clearly shown that periods of rapid weight loss further enhance the risk of cholesterol cholelithiasis [11][12][13]. In order to reduce the risk of gallstone formation and its complications, policies of routine prophylactic cholecystectomy [6], use of intra-operative ultrasound for gallstone detection and concomitant cholecystectomy [12,14,15], postoperative use of ursodeoxycholic acid [15,16], regular ultrasound surveillance for asymptomatic gallstone [12,[14][15][16], and their combinations have been suggested. However, none of these have been widely accepted as a standard of practice.…”

Concomitant versus Delayed Cholecystectomy in Bariatric Surgery

“…Scott et al reported that an advantage of delayed LC is that the procedure might be technically easier to perform as a consequence of the reduced intra-abdominal fat and liver size [ 11 ].…”

Simultaneous surgeries in bariatric surgery (literature review)

“…[14] с включением в анализ 13 765 пациентов, частота несостоятельности анастомоза после симультанной холецистэктомии и гастрошунтирования составила 8,7%, тогда как только после гастрошунтирования -2,5%. Нами найдено 16 оригинальных исследований [5,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], в которых сравнивались непосредственные результаты только гастрошунтирования и симультанной холецистэктомии с гастрошунтированием (табл. 1).…”