Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Keshavarz Blvd., Tehran, Iran.
Dig Dis Sci. 2022 Aug;67(8):4188-4194. doi: 10.1007/s10620-021-07306-6. Epub 2021 Nov 16.
BACKGROUND: A few comparative studies have assessed the incidence of symptomatic cholelithiasis after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). However, they have shown inconsistent results. The present study has been designed based on comparing LSG and LRYGB regarding the incidence of symptomatic cholelithiasis and determining factors related to symptomatic cholelithiasis development after these procedures. METHODS: This retrospective cohort study was conducted on 1163 patients aged ≥ 18 years old who underwent LRYGB (n = 377) or LSG (n = 786) from July 2006 to November 2019. The participants had no previous history of gallstones. A Cox-proportional hazard regression was used to assess associations between the types of procedures and the risk of symptomatic cholelithiasis. The univariable and then multivariable analysis were used to reveal the predictors of symptomatic cholelithiasis. RESULTS: The mean person-time follow-up was 34 months (95% CI: 32.2 to 36.1 months). The incidence of symptomatic cholelithiasis was 8.3% over the follow-up period. There was no significant association between the risk of symptomatic cholelithiasis development and the type of surgical procedure (HR: 1.35, 95% CI: 0.75 to 2.41). Females had a 2.3-fold higher risk of symptomatic cholelithiasis than males, according to the multivariable Cox regression (HR: 2.31, 95% CI: 1.23 to 4.33). In addition, there was an inverse association between the administration of UDCA and the incidence of symptomatic cholelithiasis (HR: 0.13, 95% CI: 0.01 to 0.99). Our findings indicated that age, baseline body mass index (BMI), percentage of weight loss (%WL) after three and six months following surgery, postoperative pregnancy, and obesity-related comorbidities did not predict the risk of symptomatic cholelithiasis. CONCLUSION: The present study illustrates no significant differences between LRYGB and LSG regarding symptomatic cholelithiasis occurrence. Our findings indicate that administration of UDCA has a protective effect against symptomatic cholelithiasis while, female gender is the main predictor of symptomatic cholelithiasis.
背景：有几项比较研究评估了腹腔镜袖状胃切除术（LSG）和腹腔镜 Roux-en-Y 胃旁路术（LRYGB）后有症状胆石症的发生率。然而，它们的结果并不一致。本研究旨在比较 LSG 和 LRYGB 之间有症状胆石症的发生率，并确定这些手术后发生有症状胆石症的相关因素。
方法：这是一项回顾性队列研究，纳入了 2006 年 7 月至 2019 年 11 月期间年龄≥18 岁、接受 LRYGB（n=377）或 LSG（n=786）的 1163 名患者。这些患者均无胆石症病史。采用 Cox 比例风险回归分析评估手术类型与有症状胆石症风险之间的关系。采用单变量和多变量分析揭示有症状胆石症的预测因素。
结果：平均随访时间为 34 个月（95%CI：32.2-36.1 个月）。随访期间有症状胆石症的发生率为 8.3%。手术类型与有症状胆石症发展风险之间无显著关联（HR：1.35，95%CI：0.75-2.41）。多变量 Cox 回归分析显示，女性发生有症状胆石症的风险是男性的 2.3 倍（HR：2.31，95%CI：1.23-4.33）。此外，UDCA 的使用与有症状胆石症的发生率呈负相关（HR：0.13，95%CI：0.01-0.99）。我们的研究结果表明，年龄、基线体重指数（BMI）、术后 3 个月和 6 个月的体重减轻百分比（%WL）、术后妊娠和肥胖相关合并症均不能预测有症状胆石症的风险。
结论：本研究表明 LRYGB 和 LSG 术后有症状胆石症的发生率无显著差异。我们的研究结果表明，UDCA 的使用对有症状胆石症有保护作用，而女性是有症状胆石症的主要预测因素。
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