O'Brien Paul E, Dixon John B
Monash University Department of Surgery, The Alfred Hospital, Melbourne, Victoria.
Arch Surg. 2003 Aug;138(8):908-12. doi: 10.1001/archsurg.138.8.908.
Gallstones are more common in the obese population and may be formed during rapid weight loss. A rational approach to the management of the gallbladder should be incorporated into bariatric surgical practice. It has been recommended that patients undergoing Roux-en-Y gastric bypass have routine cholecystectomy regardless of gallstone status. We analyzed the outcomes of a noninterventionist policy on 1000 patients undergoing laparoscopic adjustable gastric banding.
Patients scheduled for adjustable gastric banding should undergo investigation for and treatment of gallbladder disease regardless of symptoms.
Patients were screened preoperatively for symptoms of gallstones. Ultrasound examination was performed only in those with symptoms and, if stones were present, cholecystectomy was performed with gastric banding. The remaining patients were followed up clinically and outcomes were noted.
A total of 1000 patients were followed up for 12 to 96 months, a total of approximately 3500 patient-years. Cholecystectomy was performed in 181 patients before and 10 at gastric banding surgery. Of the 809 patients at risk, 55 (6.8%) presented with symptomatic disease during follow-up and proceeded to undergo elective cholecystectomy without complications from the disease or the treatment.
The incidence of cholecystectomy after gastric banding surgery was not different from the expected rate for a nonsurgical obese population. In contrast, after Roux-en-Y gastric bypass, a median of 40% of patients form stones in the postoperative period, and prophylactic cholecystectomy may be justified. Our data indicate that a noninterventionist approach to the gallbladder is appropriate for patients undergoing adjustable gastric banding surgery.
胆结石在肥胖人群中更为常见，且可能在快速减重过程中形成。在减重手术实践中应纳入合理的胆囊管理方法。有人建议，接受Roux-en-Y胃旁路手术的患者无论胆结石状况如何都应常规进行胆囊切除术。我们分析了对1000例行腹腔镜可调节胃束带术患者采取非干预性策略的结果。
计划行可调节胃束带术的患者无论有无症状都应接受胆囊疾病的检查和治疗。
术前对患者进行胆结石症状筛查。仅对有症状的患者进行超声检查，若发现结石，则在进行胃束带术时同时行胆囊切除术。其余患者进行临床随访并记录结果。
共对1000例患者进行了12至96个月的随访，总计约3500患者年。181例患者在术前进行了胆囊切除术，10例在胃束带手术时进行了胆囊切除术。在809例有风险的患者中，55例（6.8%）在随访期间出现症状性疾病，并接受了择期胆囊切除术，未出现疾病或治疗相关并发症。
胃束带手术后胆囊切除术的发生率与非手术肥胖人群的预期发生率无差异。相比之下，Roux-en-Y胃旁路手术后，中位有40%的患者在术后形成结石，预防性胆囊切除术可能是合理的。我们的数据表明，对于行可调节胃束带手术的患者，对胆囊采取非干预性方法是合适的。
