Department of Visceral Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, Basel, Switzerland.
Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Claraspital, Basel, Switzerland.
Surg Obes Relat Dis. 2022 Feb;18(2):182-188. doi: 10.1016/j.soard.2021.10.006. Epub 2021 Oct 15.
Rapid weight loss after bariatric surgery is a risk factor for gallstone formation. There are different strategies regarding its management in bariatric patients, including prophylactic cholecystectomy (CCE) in all patients, concomitant CCE only in symptomatic patients, or concomitant CCE in all patients with known gallstones. We present the safety and long-term results of the last concept.
Retrospective single-center analysis of a prospective database on perioperative and long-term results of patients with laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) over a 15-year period. The minimal follow-up was 24 months. Concomitant CCE was intended for all patients with gallstones detected by preoperative sonography.
Academic teaching hospital in Switzerland.
After exclusion of patients with a history of CCE (11.5%), a total of 1174 patients (69.6% LRYGB, 30.4% LSG) were included in the final analysis. Preoperative gallbladder pathology was detected in 21.2% of patients, of whom 98.4%, or 20.9% of the total patients, received a concomitant CCE. The additional procedure prolonged the average operation time by 38 minutes (not significant) and did not increase the complication rate compared with bariatric procedure without CCE (3.7% versus 5.7%, P = .26). No complication was directly linked to the CCE. Postoperative symptomatic gallbladder disease was observed in 9.3% of patients (LRYGB 7.0% versus LSG 2.3%, P = .15), with 19.8% of those patients initially presenting with a complication.
The concept of concomitant CCE in primary bariatric patients with gallstones was feasible and safe. Nevertheless, 9.3% of primary gallstone-free patients developed postoperative symptomatic gallbladder disease and required subsequent CCE despite routine ursodeoxycholic acid prophylaxis.
减重手术后的快速体重减轻是胆囊结石形成的一个风险因素。对于肥胖症患者，有不同的管理策略，包括对所有患者预防性胆囊切除术（CCE）、仅对有症状的患者同时进行 CCE、或对所有已知有胆囊结石的患者同时进行 CCE。我们介绍了最后一种概念的安全性和长期结果。
对腹腔镜 Roux-en-Y 胃旁路术（LRYGB）或腹腔镜袖状胃切除术（LSG）患者的围手术期和长期结果进行前瞻性数据库的回顾性单中心分析，时间跨度为 15 年。最小随访时间为 24 个月。对于术前超声检查发现的胆囊结石，计划对所有患者同时进行 CCE。
瑞士一所学术教学医院。
排除有 CCE 病史的患者（11.5%）后，共有 1174 名患者（69.6%为 LRYGB，30.4%为 LSG）被纳入最终分析。术前胆囊病理学在 21.2%的患者中被发现，其中 98.4%，或 20.9%的患者，接受了同时的 CCE。与未行 CCE 的减重手术相比，附加手术平均延长了 38 分钟（无显著差异），且并未增加并发症发生率（3.7%比 5.7%，P=0.26）。没有并发症与 CCE 直接相关。术后有症状的胆囊疾病在 9.3%的患者中观察到（LRYGB 为 7.0%，LSG 为 2.3%，P=0.15），其中 19.8%的患者最初出现并发症。
对原发性肥胖症患者伴胆囊结石同时行 CCE 的概念是可行和安全的。尽管常规使用熊去氧胆酸预防，仍有 9.3%的原发性无胆囊结石患者在术后发生有症状的胆囊疾病，并需要随后行 CCE。
