Amstutz Sébastien, Michel Jean-Marie, Kopp Sébastien, Egger Bernhard
Department of Surgery, HFR Fribourg Cantonal Hospital, 1708, Fribourg, Switzerland.
Department of Radiology, HFR Fribourg Cantonal Hospital, 1708, Fribourg, Switzerland.
Obes Surg. 2015 Nov;25(11):2054-60. doi: 10.1007/s11695-015-1650-6.
In patients with morbid obesity, laparoscopic Roux-en-Y gastric bypass (LRYGB) is the treatment of choice. Patients with gallstones routinely undergo cholecystectomy at the same time as LRYGB. Although the risk of developing gallstones afterwards is high, prophylactic cholecystectomy during LRYGB remains controversial. Therefore, we conducted a retrospective study to evaluate the risk associated with prophylactic cholecystectomy and risk factors for developing gallstones after LRYGB.
Data for patients on whom we consecutively performed LRYGB in 2003-2008 were extracted from the prospective bariatric database. The primary endpoint of the study was detection of newly developed gallstones by ultrasonography, and the secondary endpoint was evaluation of the incidence of post-LRYGB cholecystectomy (questionnaire).
Of 117 patients who underwent LRYGB, 20 (17 %) had a previous and 26 (22 %) had a concomitant cholecystectomy. Of the 71 LRYGB patients remaining who had not had their gallbladders removed, 22 (34 %) developed gallstones, with 11 (17 %) requiring emergency cholecystectomy before the study began. Seven (10 %) patients were lost to follow-up, and 53 (75 %) underwent abdominal ultrasound during follow-up, which detected stones in another 11 (17 %) patients up to end of the study period.
Nearly 50 % of our patients had either experienced gallstones before LRYGB or developed gallstones after LRYGB. In the group with new gallstone development, 50 % required emergency cholecystectomy. These results, together with the reported better quality of life after a combined procedure and the reported economic benefits, support the use of concomitant prophylactic cholecystectomy in patients undergoing LRYGB.
对于病态肥胖患者，腹腔镜Roux - Y胃旁路术（LRYGB）是首选治疗方法。胆结石患者通常在接受LRYGB的同时进行胆囊切除术。尽管术后发生胆结石的风险很高，但LRYGB期间进行预防性胆囊切除术仍存在争议。因此，我们进行了一项回顾性研究，以评估预防性胆囊切除术相关风险以及LRYGB术后发生胆结石的危险因素。
从前瞻性肥胖症数据库中提取2003 - 2008年间我们连续为其实施LRYGB的患者数据。该研究的主要终点是通过超声检查发现新形成的胆结石，次要终点是评估LRYGB术后胆囊切除术的发生率（问卷调查）。
在117例行LRYGB的患者中，20例（17%）既往有胆囊切除术史，26例（22%）同时进行了胆囊切除术。在其余未切除胆囊的71例LRYGB患者中，22例（34%）发生了胆结石，其中11例（17%）在研究开始前需要急诊胆囊切除术。7例（10%）患者失访，53例（75%）在随访期间接受了腹部超声检查，到研究结束时又发现另外11例（17%）患者有结石。
我们近50%的患者在LRYGB术前就有胆结石或术后发生了胆结石。在新发生胆结石的患者组中，50%需要急诊胆囊切除术。这些结果，连同联合手术术后生活质量改善的报道以及经济效益的报道，支持在接受LRYGB的患者中同时进行预防性胆囊切除术。
