DOI: http://dx.doi.org/10.18203/2349-2902.isj20185506

Effectiveness of using ursodeoxycholic acid in reducing incidence of gallstone formation after sleeve gastrectomy

Mahmoud Saad Ibrahim Elshenawy, Mohamed Sabry Ammar, Mahmoud Gamal Eldin Hagag

Abstract


Background: Obese persons are at risk for cholesterol gallstones because of high saturation of cholesterol in their bile. About 75% of gallstones are of cholesterol type. To reduce the risk for gallstone formation, policies of prophylactic cholecystectomy are proposed. However, this is not widely accepted. A routine cholecystectomy during bariatric surgery is recommended by some centers. Ursodeoxycholic acid enhances the conversion of cholesterol to bile acids. It also enhances cholesterol transport as liquid crystals. Furthermore, it has an inhibitory action on the prostaglandins and biliary glycoprotein, which is the possible explanation for its action on decreasing the saturation index. The objective was the effectiveness of using Ursodeoxycholic Acid (UDCA) in reducing incidence of gallstone formation after sleeve gastrectomy.

Methods: 50 morbid obese patients divided into 2 groups. Group A: 30 patients who received UDCA post-operative. (5 male and 25 female) with mean age 34.8year. Patients had a body mass index (BMI) with mean BMI 46.9kg/m2. Group B: 20 patients without receiving UDCA post-operative. (2 male and 18 female) with mean age 32.9year. Patients had a mean of BMI 47.3kg/m2.

Results: Using UDCA has significant role in prophylaxis against development of gall stone formation. Patients who received UDCA developed gall stones by a percentage 0% (0/30) while patients who hadn’t received UDCA developed gall stones by a percentage 4.7% (3/20).

Conclusions: The use of UCDA effectively reduced the incidence of gall stone formation after laparoscopic sleeve gastrectomy (LSG) in patient with morbid obesity.


Keywords


Gallstone formation, Morbid obesity, Sleeve gastrectomy, Ursodeoxycholic acid

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References


Brethauer SA, Chand B, Schauer PR. Risks and benefits of bariatric surgery: current evidence. Cleveland Clin J Med. 2006;73(11):993.

Pineda O, Maydón HG, Amado M, Sepúlveda EM, Guilbert L, Espinosa Oet al. A prospective study of the conservative management of asymptomatic preoperative and postoperative gallbladder disease in bariatric surgery. Obes Surg. 2017;27(1):148-53.

Elgamal A, Fawzy AT. Some risk factors of gallstone formation after laparoscopic sleeve gastrectomy and the role of ezetimibe versus ursodeoxycholic acid in its prevention. Egypt J Internal Med. 2014;26(2):75.

Adams LB, Chang C, Pope J, Kim Y, Liu P, Yates A. Randomized, prospective comparison of ursodeoxycholic acid for the prevention of gallstones after sleeve gastrectomy. Obes Surg. 2016;26(5):990-4.

Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Guven S, Spitz AF, et al. American association of clinical endocrinologists, the obesity society and American society for metabolic and bariatric surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Endocrine Prac. 2008;14(1):1-83.

Gustafsson U, Benthin L, Granström L, Groen AK, Sahlin S, Einarsson C. Changes in gallbladder bile composition and crystal detection time in morbidly obese subjects after bariatric surgery. Hepatol. 2005;41(6):1322-8.

Tsirline VB, Keilani ZM, El Djouzi S, Phillips RC, Kuwada TS, Gersin K, et al. How frequently and when do patients undergo cholecystectomy after bariatric surgery?. Surg Obes Related Dis. 2014;10(2):313-21.

Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical Practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring). 2013 Mar; 21(1):S1-27.

Manatsathit W, Leelasinjaroen P, Al-Hamid H, Szpunar S, Hawasli A. The incidence of cholelithiasis after sleeve gastrectomy and its association with weight loss: A two-centre retrospective cohort study. Inter J Surg. 2016;30:13-8.

Shaffer EA. Epidemiology of gallbladder stone disease. Best Prac Res Clin Gastroenterol. 2006;20(6):981-96.

Li VK, Pulido N, Fajnwaks P, Szomstein S, Rosenthal R. Predictors of gallstone formation after bariatric surgery: a multivariate analysis of risk factors comparing gastric bypass, gastric banding, and sleeve gastrectomy. Surg Endoscopy. 2009;23(7):1640-4.

Raziel A, Sakran N, Szold A, Goitein D. Concomitant cholecystectomy during laparoscopic sleeve gastrectomy. Surg Endoscopy. 2015;29(9):2789-93.

Worni M, Guller U, Shah A, Gandhi M, Shah J, Rajgor D, et al. Cholecystectomy concomitant with laparoscopic gastric bypass: a trend analysis of the nationwide inpatient sample from 2001 to 2008. Obes Surg. 2012;22(2):220-9.

Patel JA, Patel NA, Piper GL, Smith DE, Malhotra G, Colella JJ. Perioperative management of cholelithiasis in patients presenting for laparoscopic Roux-en-Y gastric bypass: have we reached a consensus?. Am Surg. 2009;75(6):470-6.

Miller K, Hell E, Lang B, Lengauer E. Gallstone formation prophylaxis after gastric restrictive procedures for weight loss: a randomized double-blind placebo-controlled trial. Ann Surg. 2003;238(5):697.

Uy MC, Talingdan-Te MC, Espinosa WZ, Daez ML, Ong JP. Ursodeoxycholic acid in the prevention of gallstone formation after bariatric surgery: a meta-analysis. Obes Surg. 2008;18(12):1532-8.

Abdallah E, Emile SH, Elfeki H, Fikry M, Abdelshafy M, Elshobaky A, et al. Role of ursodeoxycholic acid in the prevention of gallstone formation after laparoscopic sleeve gastrectomy. Surg Today. 2017;47(7):844-50.