title: Gallstone Disease After Laparoscopic Sleeve Gastrectomy in an Asian Population-What Proportion of Gallstones Actually Becomes Symptomatic?
abstract: Despite evidence on gallstone disease after laparoscopic sleeve gastrectomy (LSG), there is an existing lack of consensus on practice guidelines, i.e., surveillance and stone-lowering prophylaxis. Available evidence also has a racial bias as western reports predominate current data. Considering the growing popularity of LSG in Asia and the unique Asian anthropometrics, we have attempted to provide a regional perspective by reviewing our LSG database to investigate the epidemiology of this complication.
  
  
  
  One hundred two morbidly obese cases were retrospectively reviewed. Abdominal ultrasounds were conducted preoperatively and at 12-month post-op. No gallstone-lowering prophylaxis was used. Outcome measure was the incidence of new gallstone formation at 1 year and the rate of symptomatic stones during the follow-up period.
  
  
  
  Mean age was 43 years (range 20-68) with average initial BMI of 41.68 kg/m2. Preoperative gallstones were present in 14 (13.7%) cases. At 12-month post-op, 24 (27.5%) patients with no previous gallstone disease developed new stones. Within the mean follow-up period of 28.4 months, only one case (0.9%) developed gallstone complication requiring a cholecystectomy. We found no statistical difference in demographics, BMI variables (initial BMI, ΔBMI at 6 months and 1 year), and comorbidities between patients with new gallstone and those without stones.
  
  
  
  Our results match western data in that gallstone formation is common after LSG though incidence of complicated stones is small. This is despite not using gallstone-lowering prophylaxis. The low conversion rate also questions the relevance of surveillance screening, as most patients with new gallstones remain asymptomatic at least in the short-term follow-up.
authors.affiliation: Division of General Surgery (Upper Gastrointestinal Surgery), University Surgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore.
authors.forename: Muhammed Yaser
authors.initials: MY
authors.lastname: Hasan
authors.affiliation: Division of General Surgery (Upper Gastrointestinal Surgery), University Surgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore.
authors.forename: Davide
authors.initials: D
authors.lastname: Lomanto
authors.affiliation: Division of General Surgery (Upper Gastrointestinal Surgery), University Surgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore.
authors.forename: Lee Leng
authors.initials: LL
authors.lastname: Loh
authors.affiliation: Division of General Surgery (Upper Gastrointestinal Surgery), University Surgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore.
authors.forename: Jimmy Bok Yan
authors.initials: JBY
authors.lastname: So
authors.affiliation: Division of General Surgery (Upper Gastrointestinal Surgery), University Surgical Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore. CFsasim@nus.edu.sg.
authors.forename: Asim
authors.initials: A
authors.lastname: Shabbir
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data; D042882:Gallstones / Q000453:epidemiology / Q000503:physiopathology; D005743:Gastrectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Bariatric surgery; Cholelithiasis; Gastric restrictive procedure; Ursodeoxycholic acid; Weight management