title: Management of gallbladder disease after sleeve gastrectomy in a selected Lebanese population.
abstract: BACKGROUND
  Patients with morbid obesity are at a higher risk of developing gallstones after bariatric surgery. Studies on the incidence of symptomatic gallstones necessitating cholecystectomy after laparoscopic sleeve gastrectomy (LSG) are limited in the Middle East.
  
  
  OBJECTIVE
  This study aims to assess the incidence of cholecystectomy after LSG during a 1-year follow-up and to evaluate potential risk factors and potential prophylactic measures.
  
  
  METHODS
  Two university hospitals in Lebanon.
  
  
  METHODS
  A prospectively maintained bariatric database of 361 patients who underwent primary LSG between January 2009 and December 2012 at the American University of Beirut Medical Center and Makassed General Hospital was reviewed. Data included demographics, preoperative weight, weight at 6 and 12 months postoperatively, and incidence of postoperative symptomatic cholelithiasis.
  
  
  RESULTS
  A total of 319 patients (88.4%) were followed up at 1 year. Twenty-four (7.5%) had symptomatic gallstones and underwent cholecystectomy after LSG. Mean postoperative time for the development of symptomatic gallstones was 426 days (range, 91-1234 days). Patients who developed symptomatic gallstones were significantly younger (29.8 versus 34.8, P = 0.008) but comparable to patients who did not undergo cholecystectomy in terms of other baseline characteristics and weight loss results at 1 year. Out of the obesity-related co-morbidities, hypertension was the only co-morbidity associated with post-LSG cholecystectomy (OR = 3.35, P = 0.036) after multivariate adjustment.
  
  
  CONCLUSIONS
  The incidence of symptomatic gallstones requiring cholecystectomy after LSG in our study cohort was higher than that of the general population (7.5%). This incidence does not warrant prophylactic cholecystectomy or routine pre- or postoperative ultrasounds.
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Hanaa
authors.initials: H
authors.lastname: Dakour Aridi
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Serge
authors.initials: S
authors.lastname: Sultanem
authors.affiliation: Department of Surgery, Makassed General Hospital, Beirut, Lebanon.
authors.forename: Houssam
authors.initials: H
authors.lastname: Abtar
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Bassem Y
authors.initials: BY
authors.lastname: Safadi
authors.affiliation: Department of Surgery, Makassed General Hospital, Beirut, Lebanon.
authors.forename: Hayssam
authors.initials: H
authors.lastname: Fawal
authors.affiliation: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. Electronic address: ra204@aub.edu.lb.
authors.forename: Ramzi S
authors.initials: RS
authors.lastname: Alami
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D002763:Cholecystectomy / Q000379:methods; D005260:Female; D042882:Gallstones / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors