title: Prevalence of Cholelithiasis and Choledocholithiasis in Morbidly Obese South Indian Patients and the Further Development of Biliary Calculus Disease After Sleeve Gastrectomy, Gastric Bypass and Mini Gastric Bypass.
abstract: Evaluation of the prevalance of cholelithiasis, choledocholithiasis and there management after sleeve gastrectomy, gastric bypass and mini gastric bypass in Indian bariatric patients.
  
  
  
  We did a retrospective analysis of our bariatric patient from January 2007 to December 2013 (n = 1397), for prevalence of cholelithiasis and choledocholithiasis. We did synchronous cholecystectomy in all patients planned for bariatric surgery found to have cholelithiasis on USG. Post-operatively, we followed all the patients with gallbladder in situ for minimum of 18-88 months (mean -32.4) and reviewed data for subsequent development of cholelithiasis/choledocholithiasis. Only those patients who were symptomatic underwent intervention.
  
  
  
  Prevalence of cholelithiasis and choledocholithiasis in our study was 21.76 and 9.63 %, respectively. The incidence of post-bariatric surgery development of cholelithiasis was 10.53 %; individually, it was 8.42 % in LSG group, 13.4 % in LRYGB group and 12.7 % in MGB patients. The incidence of symptomatic cholelithiasis requiring surgery was 1.94 % after LSG, 4.54 % after LRYGB and 4.25 % after MGB. Post-surgery, six patients developed choledocholithiasis. In our post-bariatric group, the 33 patients who developed symptomatic stones had percentage total weight loss of 30.99 + 4.1 (P < 0.001). The average time period for readmission of symptomatic patient was 11.26 + 2.67 months.
  
  
  
  We recommend routine synchronous cholecystectomy with bariatric procedure. In spite of synchronous cholecystectomy, incidence of cholelithiasis in our post-bariatric patient is 10.53 % of which up to one third were symptomatic and required surgery, and incidence of choledocholithiasis is comparable to that of general population.
authors.affiliation: Department of Minimal Access and Bariatric Surgery, Global Hospitals, Hyderabad, India. tapasmishra08@gmail.com.
authors.forename: Tapas
authors.initials: T
authors.lastname: Mishra
authors.affiliation: Department of Minimal Access and Bariatric Surgery, Global Hospitals, Hyderabad, India.
authors.forename: Kona Kumari
authors.initials: KK
authors.lastname: Lakshmi
authors.affiliation: Department of Gastroenterology, Global Hospitals, Hyderabad, India.
authors.forename: Kiran Kumar
authors.initials: KK
authors.lastname: Peddi
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000706:statistics & numerical data*; D002763:Cholecystectomy / Q000706:statistics & numerical data; D042883:Choledocholithiasis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D002769:Cholelithiasis / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D006801:Humans; D007194:India / Q000453:epidemiology; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies
keywords: Choledocholithiasis; Cholelithiasis; ERCP; Gastric bypass; Mini gastric bypass; Morbid obesity; Sleeve gastrectomy; Transgastric endoscopic papillotomy