title: Prevalence of gallstones in 1,229 patients submitted to surgical laparoscopic treatment of GERD and esophageal achalasia: associated cholecystectomy was a safe procedure.
abstract: BACKGROUND
  Association between esophageal achalasia/ gastroesophageal reflux disease (GERD) and cholelithiasis is not clear. Epidemiological data are controversial due to different methodologies applied, the regional differences and the number of patients involved. Results of concomitant cholecistectomy associated to surgical treatment of both diseases regarding safety is poorly understood.
  
  
  OBJECTIVE
  To analyze the prevalence of cholelithiasis in patients with esophageal achalasia and gastroesophageal reflux submitted to cardiomyotomy or fundoplication. Also, to evaluate the safety of concomitant cholecistectomy.
  
  
  METHODS
  Retrospective analysis of 1410 patients operated from 2000 to 2013. They were divided into two groups: patients with GERD submitted to laparocopic hiatoplasty plus Nissen fundoplication and patients with esophageal achalasia to laparoscopic cardiomyotomy plus partial fundoplication. It was collected epidemiological data, specific diagnosis and subgroups, the presence or absence of gallstones, surgical procedure, operative and clinical complications and mortality. All groups/subgroups were compared.
  
  
  RESULTS
  From 1,229 patients with GERD or esophageal achalasia, submitted to laparoscopic cardiomyotomy or fundoplication, 138 (11.43%) had cholelitiasis, occurring more in females (2.38:1) with mean age of 50,27 years old. In 604 patients with GERD, 79 (13,08%) had cholelitiasis. Lower prevalence occurred in Barrett's esophagus patients 7/105 (6.67%) (p=0.037). In 625 with esophageal achalasia, 59 (9.44%) had cholelitiasis, with no difference between chagasic and idiopathic forms (p=0.677). Complications of patients with or without cholecystectomy were similar in fundoplication and cardiomyotomy (p=0.78 and p=1.00).There was no mortality or complications related to cholecystectomy in this series.
  
  
  CONCLUSIONS
  Prevalence of cholelithiasis was higher in patients submitted to fundoplication (GERD). Patients with chagasic or idiopatic forms of achalasia had the same prevalence of cholelithiasis. Gallstones occurred more in GERD patients without Barrett's esophagus. Simultaneous laparoscopic cholecystectomy was proved safe.
authors.affiliation: Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Rubens Antonio Aissar
authors.initials: RA
authors.lastname: Sallum
authors.affiliation: Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Eduardo Messias Hirano
authors.initials: EM
authors.lastname: Padrão
authors.affiliation: Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Sergio
authors.initials: S
authors.lastname: Szachnowicz
authors.affiliation: Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Francisco C B C
authors.initials: FC
authors.lastname: Seguro
authors.affiliation: Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Edno Tales
authors.initials: ET
authors.lastname: Bianchi
authors.affiliation: Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Ivan
authors.initials: I
authors.lastname: Cecconello
mesh_terms: D002763:Cholecystectomy; D004931:Esophageal Achalasia / Q000150:complications / Q000601:surgery*; D005260:Female; D042882:Gallstones / Q000150:complications / Q000453:epidemiology* / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies