Risk of Asymptomatic Gallstones Becoming Symptomatic After Laparoscopic Sleeve Gastrectomy
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Abstract:
Whether concomitant cholecystectomy is needed during laparoscopic sleeve gastrectomy (LSG) in patients with asymptomatic cholelithiasis is controversial. In this study, our aim is to show the follow-up results in patients with asymptomatic cholelithiasis who underwent LSG alone.Patients undergoing primary LSG between March 2018 and September 2020 with asymptomatic gallbladder stones were included in this retrospective study. All patients underwent abdominal ultrasound (US) before surgery. Patients' demographics and postoperative outcomes were recorded.A total of 180 patients underwent primary LSG and completed the 1-year follow-up. The study population consisted of 42 patients (23%) with asymptomatic cholelithiasis. The mean age was 41.1±7.1 years (31-56, 63% female), and mean body mass index (BMI) was 44 ± 6.7 kg/m2. Average BMI decreased to 31.1 ± 4.7 kg/m2 at 6 months and to 27.3 ± 3.6 kg/m2 at 1 year. The average follow-up period was 17 ± 5.7 months (range, 12-28 months). Of the 42 patients, only 1 patient (2.4%) became symptomatic during the follow-up period.We do not recommend cholecystectomy in patients with asymptomatic gallstones during the same session with LSG. An observational approach should be adopted for these patients.Keywords:
Sleeve gastrectomy
Concomitant
The prevalence of gallstones and gallbladder disease was studied between October 1973 and June 1976 in Canadian Micmac Indian women aged 15 to 50 years in an inland rural community near Shubenacadie, NS. Of 132 women at risk 98 underwent cholecystography, 6 had a history of cholecystectomy (verified from hospital records) and 3 had cholecystectomy because of cholecystitis during the 3 years of the study. Of the 17 abnormal cholecystograms 10 showed radiolucent gallstones, and repeated studies documented gallstones in 6 of the 7 radiographs on which the gallbladder was not visualized. The prevalence of gallstones was found to be 211/1000, and that of gallbladder disease, 240/1000. The peak prevalence was at 30 to 39 years of age. The women with gallbladder disease were significantly more obese and of greater parity than those without gallbladder disease even when age was controlled. The Micmac Indian women of Nova Scotia appear to be at a much higher risk for the development of cholesterol gallstones and gallbladder disease than Caucasian women in Framingham, Massachusetts.
Gallbladder disease
Cholecystography
Framingham Heart Study
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(1) In 24,089 autopsy records from 1956 to 1979 we found in 16,653 corpses without gallstones 495 = 2.97%, and in 7,436 corpses with gallstones 266 = 3.57% colorectal cancers.--(2) In 503 corpses with previous cholecystectomy performed more than one year before death we found 17 = 3.38% colorectal cancers.--(3) There is no higher incidence of colorectal cancer after cholecystectomy.--(4) In the corpses with gallstones, cholecystectomy or cirrhosis of the gallbladder there were significantly more cancers in the right hemicolon than in corpses without gallstones.--(5) A synetiology by genetic, epidemiologic or (and) metabolic factors may be possible.--(6) A Co-influence of primary bile acids on the genesis of colorectal cancer is discussed.--(7) In patients over 50 years with gallstones it is mandatory for the surgeon to exclude a co-existing colorectal cancer before performing cholecystectomy.
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Obesity is an independent risk factor for gallstones. In obese patients, gallstone is more symptomatic than in non-obese people.To present the early results of laparoscopic sleeve gastrectomy (LSG) and concomitant cholecystectomy (CC) performed in patients with symptomatic gallstone accompanied by at least one additional systemic disease to obesity and to investigate its effect on morbidity.Patients undergoing sleeve gastrectomy for morbid obesity between January 2016 and August 2018 were retrospectively studied. Twenty-seven patients who underwent laparoscopic sleeve gastrectomy and concomitant cholecystectomy due to symptomatic gallstone stones were included in this study. The patients were divided into two groups according to the applied surgical technique: laparoscopic sleeve gastrectomy and concomitant cholecystectomy (n = 27) and laparoscopic sleeve gastrectomy (n = 70). The results of an additional operation on these patients and their perioperative complications were evaluated.A total of 97 patients were included in the study. The mean age of the patients was 40.58 ±10.36 years. There was no statistically significant difference between groups in terms of complications (p = 0.669). The difference in the duration of the operation was statistically significant (p < 0.001).Concomitant cholecystectomy may be presented as an alternative surgical procedure due to the demonstration that concomitant cholecystectomy can be performed safely in comorbid obese patients, with a risk of becoming symptomatic in the rest of life at a certain rate, and low risk of complications in asymptomatic patients.
Concomitant
Sleeve gastrectomy
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Prior studies indicate a possible association between depression and cholecystectomy, but no study has compared the risk of post-operative depressive disorders (DD) after cholecystectomy. This retrospective follow-up study aimed to examine the relationship between cholecystectomy and the risk of DD in patients with gallstones in a population-based database.Using ambulatory care data from the Longitudinal Health Insurance Database 2000, 6755 patients who received a first-time principal diagnosis of gallstones at the emergency room (ER) were identified. Among them, 1197 underwent cholecystectomy. Each patient was then individually followed-up for two years to identify those who were later diagnosed with DD. Cox proportional hazards regressions were performed to estimate the risk of developing DD between patients with gallstone who did and those who did not undergo cholecystectomy.Of 6755 patients with gallstones, 173 (2.56%) were diagnosed with DD during the two-year follow-up. Among patients who did and those who did not undergo cholecystectomy, 3.51% and 2.36% later developed depressive disorder, respectively. After adjusting for the patient's sex, age and geographic location, the hazard ratio (HR) of DD within two years of gallstone diagnosis was 1.43 (95% CI, 1.02-2.04) for patients who underwent cholecystectomy compared to those who did not. Females, but not males, had a higher the adjusted HR of DD (1.61; 95% CI, 1.08-2.41) for patients who underwent cholecystectomy compared to those who did not.There is an association between cholecystectomy and subsequent risk of DD among females, but not in males.
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Etiology
Gallbladder disease
Abdominal ultrasonography
Abdominal ultrasound
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Introduction: Morphology of gallbladder varies considerably from person to person.We believe that one of the morphological variations of gallbladder is the "gallbladder angle".Gallbladder varies also in "angle", which, to the best of our knowledge, has never been investigated before.The purpose of this study was to investigate the impact of gallbladder angle on gallstone formation.Methods: in this study, 1075 abdominal computed tomography (CT) images were retrospectively examined.Patients with completely normal gallbladders were selected.Among these patients, those with both abdominal ultrasound and blood tests were identified in the hospital records and included in the study.Based on the findings of the ultrasound scans, patients were divided into two groups as patients with gallstones and patients without gallstones.Following the measurement of gallbladder angles on the CT images, the groups were statistically evaluated.Results: The gallbladder angle was smaller in patients with gallstones (49 ± 21 degrees and 53 ± 19 degrees) and the gallbladder with larger angle was 1.015 (1/0.985)times lower the risk of gallstone formation.However, these were not statistically significant (p>0,05).Conclusion: A more vertically positioned gallbladder does not affect gallstone formation.However, a smaller gallbladder angle may facilitate gallstone formation in patients with the risk factors.Gallstones perhaps more easily and earlier develop in gallbladders with a smaller angle.
Gallbladder Stone
Abdominal ultrasound
Gallbladder disease
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The objective of this study was to examine the in vitro responsiveness to cholecystokinin-8 of gallbladder muscle strips from patients with gallstones and to correlate the findings with preoperative ultrasonographic studies of gallbladder contractility. The response of gallbladder muscle strips to cholecystokinin-8 of patients with noncontracting gallbladders was significantly reduced in comparison to that of patients with gallstones whose gallbladders contracted in response to fat.
Contractility
Cholecystography
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In 1,000 cholecystectomies for symptomatic presumed benign disease, 23 gallbladder cancers were unexpectedly found. Only six of these 23 patients seemed to benefit from the surgical intervention. In view of the mortality of 0.8% of all cholecystectomies performed, it can be concluded that cholecystectomy for symptomatic gallstones is inadequate to prevent mortality from unexpected gallbladder cancer. To improve the overall prognosis of gallbladder cancer, it is therefore suggested to perform prophylactic cholecystectomy for silent gallstones.
Gallbladder Cancer
Gallbladder disease
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An examination of 613 post‐mortems gave a prevalence of biliary disease at autopsy of 36.5%. higher than reported previously in Australia. This consisted of an asymptomatic gallstone prevalence of 18.9%. with a further 5.78 of the autopsies having granular biliary sludge and 11.9% having had a previous cholecystec‐toniy. Although the rate of occurrence of cholesterol gallstones was approximately half that of the pigment gallstones and pigment biliary sludge combined. no significant association between the sex of the postmortems and stone type was observed at autopsy (χ 2 1 = 0.1; P > 0.05). The ratio of biliary disease between females and males was approximately 2:1. Gallstones and biliary sludge from 310 cholecystectomy patients showed that cholesterol gallstones were approximately twice as common in men, and approximately six times as common in women than pigment gallstones. In this group of patients there was a significant association between the sex of the patient and the rate of occurrence of stone type. The rate of occurrence of cholesterol gallstones was significantly higher than pigment gallstones in both the males and females at cholecystectomy (χ 2 1 = 18.97; P < 0.0001). A female to male ratio of approximately 2:1 was also observed. A statistically significantly higher rate of pigmented biliary disease was observed at autopsy than at cholecystectomy. (χ 2 1 = 101.0; P< 0.0001). Analyses on biliary sludge. a filterable, fine granular pigmented material in bile. suggest that it may be the direct precursor for a number of different gallstone types.
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Gallbladder disease
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