Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
Department of General Surgery, Orlando Regional Medical Center, Orlando Health, Orlando, Florida.
Surg Obes Relat Dis. 2014 Jan-Feb;10(1):64-8. doi: 10.1016/j.soard.2013.04.019. Epub 2013 Jun 4.
Rapid weight loss after bariatric surgery has been a factor of inducing gallstones postoperatively. Many studies have reported increased gallstone formation after laparoscopic Roux-en-Y gastric bypass (LRYGB). However, not many studies have compared symptomatic gallstone frequencies between LRYGB, laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB). The aim of our study is to evaluate symptomatic cholelithiasis cases requiring cholecystectomy after each bariatric procedure.
Between January 2009 and August 2011, a total of 937 patients underwent bariatric surgery at our institution. Of these patients, 598 had primary LRYGB, 197 had LSG, and 142 had LAGB. We excluded patients with previous cholecystectomy or concomitant cholecystectomy at the time of bariatric procedure. A retrospective review of a prospectively collected database was performed for all patients.
Of 367 LRYGB patients, 5.7% (n = 21) had symptomatic gallstones. Of 115 LSG patients, 6.1% (n = 7) required cholecystectomy, and of 104 LAGB patients, .0% (n = 0) developed symptomatic gallstones. The differences in the occurrences of symptomatic gallstones between LRYGB and LSG were not statistically significant (P>.88). However, statistical significance was present between LRYGB and LAGB (P<.02), as well as between LSG and LAGB (P<.02). Mean percentage of excess weight loss (%EWL) at 24 months was 85.7%, 58.8%, and 38.3% in LRYGB, LSG, and LAGB patients, respectively. There was no complication related to the cholecystectomy procedure.
Frequency of symptomatic gallstones after LRYGB and LSG was not significantly different and after LAGB was significantly lower. Slow and less amount of weight loss would have contributed to the low rate of symptomatic gallstone formation in the LAGB patients.
减重手术后的快速体重减轻是术后诱导胆囊结石的一个因素。许多研究报告腹腔镜 Roux-en-Y 胃旁路术（LRYGB）后胆囊结石形成增加。然而，很少有研究比较 LRYGB、腹腔镜袖状胃切除术（LSG）和腹腔镜可调胃带术（LAGB）术后症状性胆囊结石的频率。我们研究的目的是评估每种减肥手术后需要胆囊切除术的症状性胆石症病例。
2009 年 1 月至 2011 年 8 月，我院共 937 例患者接受了减肥手术。其中 598 例行原发性 LRYGB，197 例行 LSG，142 例行 LAGB。我们排除了既往有胆囊切除术或减肥手术时同时行胆囊切除术的患者。对所有患者进行前瞻性收集数据库的回顾性审查。
在 367 例 LRYGB 患者中，有 5.7%（n=21）出现症状性胆石症。在 115 例 LSG 患者中，有 6.1%（n=7）需要行胆囊切除术，在 104 例 LAGB 患者中，无（n=0）发生症状性胆石症。LRYGB 和 LSG 之间症状性胆石症的发生率无统计学差异（P>.88）。然而，LRYGB 与 LAGB（P<.02）以及 LSG 与 LAGB（P<.02）之间存在统计学差异。LRYGB、LSG 和 LAGB 患者 24 个月时的体重减轻百分比（%EWL）分别为 85.7%、58.8%和 38.3%。胆囊切除术无并发症。
LRYGB 和 LSG 术后症状性胆囊结石的发生率无显著差异，而 LAGB 术后发生率显著降低。体重减轻缓慢且幅度较小可能导致 LAGB 患者症状性胆囊结石形成率较低。
