Morbid obezite nedeniyle Roux en-Y gastrik bypass yapilan hastalarda safra kesesi taşi oluşumunun değerlendirilmesi The evaluation of gallstone formation in patients undergoing Roux-en -Y gastric bypass due to morbid obesity

Amac: Bu calismada morbid obezlerde uygulanan laparoskopik Roux-en-Y gastrik bypass (LRYGB) sonrasi safra kesesi tasi olusumunun, profilaktik ve selektif kolesistektomi ile ursodeoksikolik asit kullaniminin yerinin degerlendiril- mesi amaclanmistir. Gerec ve Yontemler: Ekim 2006 ile Mart 2011 tarihleri arasinda LRYGB teknigi uygulanan 60 hastanin dosyalari geriye donuk incelendi. Hastalar safra kesesi tasi olusumu acisindan degerlendirildi. Bulgular: Hastalarin 53'u (%88,3) kadin, yedisi (%11,7) erkekti. Opere edilen 60 hastanin sekizi (%13,3) kolesistekto- miliydi. Preoperatif ultrasonografide safra kesesi tasi saptanan alti hastaya (%11,5) LRYGB'ye ilaveten kolesistektomi yapildi. Geriye kalan 46 hasta ortalama 28,57 ay (5-56 ay) takip edildi. Bu hastalarin 10'unda (%21,7) safra kesesi tasi saptandi ve semptomatik safra tasi olan bes hastaya kolesistektomi uygulandi. LRYGB sonrasi, safra tasi gelisen ve gelismeyen hastalar karsilastirildiginda, yas, cinsiyet ve yeni vucut kitle indeksleri arasinda anlamli bir fark ol- madigi goruldu. Uc hastaya ursodeoksikolik asit baslandi ve alti ay kadar devam edildi. Bu hastalarda safra kesesi tasi saptanmadi. Sonuc: Verilerimiz isiginda, LRYGB sonrasi hastalarin cok az bir kisminda semptomatik safra tasi olustugundan, onerimiz profilaktik yaklasim yerine hastalarin takibi ve semptomatik safra tasi varsa kolesistektomi yapilmasi ya da ursodeoksikolik asit kullanilmasidir. Tum bunlarla beraber sonuclarin desteklenmesi icin daha fazla olgu iceren prospektif randomize kontrollu calismalara ihtiyac vardir. Results: Fifty-three (88.3%) patients were female and seven (11.7%) were male. Eight of the 60 patients (13.3%) had previously undergone cholecystectomy. Six patients (11.5%) underwent cholecystectomy in addition to LRYGB due to preoperatively detected gallstones by ultrasonography. The remaining 46 patients were followed up for a mean duration of 28.57 months (5-56 months). In 10 (21.7%) of these patients, gallstones were detected and five patients with symptomatic gallstones underwent cholecystectomy. Patients who did and did not develop gallstones after LRYGB did not show a significant difference regarding age, gender and the new body mass index (BMI). Three pa- tients were started on ursodeoxycholic acid and the treatment was continued for six months. Gallstones were not detected in these patients. Conclusion: In light of these data, since only a very small portion of patients develops symptomatic gallstones after LRYGB, we recommend cholecystectomy in patients with symptomatic gallstones or the use of ursodeoxycholic acid rather than a prophylactic approach. Prospective randomized controlled studies in larger series are required to support these results.