Reduction of Cholelithiasis after Bariatric Surgery

Abstract Background: Gallstones are common in the Bariatric patients and may be formed during rapid weight loss period. A rational approach to the management of the gallbladder should be incorporated into bariatric surgical practice. It has been recommended that patients undergoing roux-en-y gastric bypass have routine cholecystectomy regardless of gallstone status. A combined prospective and retrospective study to evaluate the outcome of cholecystectomy rates in Bariatric patients have one of three bariatric procedures (LRYGB, LSG, and LGB), evaluated with a median follow-up 24 months. The highest cholecystectomy rate was found in LRYGB group (10.6%) and the frequency was highest within the first 6 months (3.7%). Aim of Study: To evaluate the prophylactic measures for prevention of gallstone formation after bariatric surgery and to identify risk factors. Patients and Methods: A total of 120 obese patients were included in the study. Pre-operative assessment was performed, including: History, examination, obesity evaluation (body weight, BMI, waist circumference), full laboratory study, gastroscopy, and abdominal ultrasonography. After laparo-scopic sleeve gastrectomy, patients were divided randomly into: Group 1 (control), Group 2 (urso-deoxycholic acid), and Group 3 (ezetimibe) and Group 4 (combined drug therapy). Patients were scheduled for 3, 6, and 12 month visits for assessment. Results: A significant reduction in gallstone formation was found in group 3 "ezetimibe" (5.5%) and group 4 "com-bined medication" compared with the group 1 "control" (17.6%). A statistically significant increase in % excess weight loss was observed in patients with gallstones (38.5%) versus patients without gallstones (28.2%). Percentage of gallstone formation during first 6 months post-operatively was double that during the next 6 months in both the control and treatment groups. Conclusions: The rapid weight loss after bariatric surgery is the most important predisposing cause for gallstones for-mation. These can cause serious problems such as acute cholecystitis, choledocholithiasis and pancreatitis. Clinicians should be cautious in terms of cholelithiasis in patients with complaints of abdominal pain during the post-operative followup period. In such a case, the abdominal ultrasound should definitely confirm.