Symptomatic gallstones after sleeve gastrectomy.
BACKGROUND
Cholelithiasis is a common complication after bariatric surgery. Pure restrictive procedures such as sleeve gastrectomy and gastric banding theoretically should result in less gallstone formation because the food continues to follow the normal gastrointestinal transit, maintaining the enteric-endocrine reflex intact. To the authors' knowledge, the literature has no studies that analyze the incidence of gallstone formation after sleeve gastrectomy. This study aimed to compare the rates of symptomatic gallstones between laparoscopic Roux-en-Y gastric bypass (RYGBP) and sleeve gastrectomy (SG).


METHODS
A retrospective chart review of patients who underwent laparoscopic RYGBP and SG between 2004 and 2006 was performed. The patients with previous cholecystectomy, known gallstones with or without concomitant cholecystectomy, and previous weight-reduction operations were excluded from the analysis. The outcome measures were the numbers of patients who had experienced symptomatic and complicated gallstones. Using Cox regression analysis, comparisons was made between the patients with laparoscopic RYGBP (group A) and those with laparoscopic SG (group B).


RESULTS
Groups A excluded 174 (26%) of 670 patients, and group B excluded 27 (34.2%) of 79 patients. The patients in group A had a significantly higher preoperative body mass index (BMI) than those in group B. Additionally, more group A than group B patients had a BMI exceeding 45 and more than a 25% loss of original weight. No significant difference in the development of symptomatic (8.7% vs. 3.8%; p = 0.296) or complicated (1.8% vs. 1.9%; p = 0.956) gallstones was noted between the two groups


CONCLUSIONS
There was no significant difference in symptomatic or complicated gallstone disease between the patients treated with laparoscopic SG and those treated with laparoscopic RYGBP. Routine prophylactic cholecystectomy should not be recommended for weight reduction during laparoscopic SG.
The Bariatric and Metabolic Institute, Section of Minimally Invasive and Endoscopic Surgery, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
Vicky Ka Ming
VK
Li
Nestor
N
Pulido
Pedro
P
Martinez-Suartez
Patricio
P
Fajnwaks
Hei Ying
HY
Jin
Samuel
S
Szomstein
Raul J
RJ
Rosenthal
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000453:epidemiology* / Q000209:etiology; D015390:Gastric Bypass / Q000009:adverse effects* / Q000379:methods; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D055815:Young Adult