The evaluation of gallstone formation in patients undergoing Roux-en-Y gastric bypass due to morbid obesity

Abstract

Objective: This study aimed to evaluate gallstone formation, prophylactic and selective cholecystectomy and the effectiveness of ursodeoxycholic acid treatment following laparoscopic Roux-en-Y gastric bypass (LRYGB) in morbid obese patients.

Material and methods: Files of 60 patients who underwent LRYGB between October 2006 and March 2011 were retrospectively reviewed. Patients were evaluated for formation of gallstones.

Results: Fifty-three (88.3%) patients were female and seven (11.7%) were male. Eight of the 60 patients (13.3%) had previously undergone cholecystectomy. Six patients (11.5%) underwent cholecystectomy in addition to LRYGB due to preoperatively detected gallstones by ultrasonography. The remaining 46 patients were followed up for a mean duration of 28.57 months (5-56 months). In 10 (21.7%) of these patients, gallstones were detected and five patients with symptomatic gallstones underwent cholecystectomy. Patients who did and did not develop gallstones after LRYGB did not show a significant difference regarding age, gender and the new body mass index (BMI). Three patients were started on ursodeoxycholic acid and the treatment was continued for six months. Gallstones were not detected in these patients.

Conclusion: In light of these data, since only a very small portion of patients develops symptomatic gallstones after LRYGB, we recommend cholecystectomy in patients with symptomatic gallstones or the use of ursodeoxycholic acid rather than a prophylactic approach. Prospective randomized controlled studies in larger series are required to support these results.

Keywords: Obesity; gallstones; laparoscopic gastric bypass.

Figure 1.

Flow-chart in obesity and gallstones LC: laparoscopic cholecystectomy; LRYGB: laparoscopic Roux-en-Y gastric by-pass; US: ultrasonography