Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
World J Surg. 2022 Jul;46(7):1721-1733. doi: 10.1007/s00268-022-06557-2. Epub 2022 Apr 10.
Obesity is a severe health problem. Gallstones may symptomatize after sleeve gastrectomy (SG). Concomitant laparoscopic cholecystectomy (LC) with SG is controversial. The effects of SG and LC versus delayed LC following SG in obese patients with asymptomatic gallbladder stones were evaluated.
A randomized trial of 222 morbidly obese patients with gallbladder stones divided them into two equal groups: SG + LC and SG-only. This multicenter study conducted from January 2016 to January 2019.
Except for operative time and postoperative hospital stay, there was no statistically significant difference between LSG + LC group and SG group (P < 0.001). In SG + LC group, LC added 40.7 min to SG, three patients (3%) required conversion, early postoperative complications occurred in 9 cases (9/111, 9%), three cases required re-intervention (3%). In SG group, the complicated cases required LC were 61 cases (61/111, 55%). Acute cholecystitis (26/61, 42.7%) was the most common gallstone symptoms. Most complicated cases occurred in the first-year follow-up (52/61, 85%). In the delayed LC group (61 patients), operative time was 50.13 ± 1.99 min, open conversion occurred in 2 cases (2/61, 3.2%), early postoperative complications occurred in four patients (4/61, 6.4%) and postoperative re-intervention were due to bile leaks and cystic artery bleeding (2/61, 3.2%).
SG with LC prolongs the operative time and hospital stay, but the perioperative complications are the same as delayed LC; LC with SG minimizes the need for a second surgery. Concomitant LC with SG is safe.
肥胖是一个严重的健康问题。胃袖状切除术（SG）后可能会出现胆石症。同时行腹腔镜胆囊切除术（LC）与 SG 存在争议。本研究评估了 SG 联合 LC 与 SG 后延迟行 LC 治疗肥胖合并无症状胆囊结石患者的效果。
对 222 例患有胆囊结石的病态肥胖患者进行随机试验，将其分为两组：SG+LC 组和 SG 组。该多中心研究于 2016 年 1 月至 2019 年 1 月进行。
除手术时间和术后住院时间外，SG+LC 组和 SG 组之间无统计学差异（P<0.001）。在 SG+LC 组中，LC 增加了 SG 手术时间 40.7 分钟，有 3 例（3%）需要中转开腹，9 例（9/111，9%）发生早期术后并发症，有 3 例（3%）需要再次介入治疗。在 SG 组中，需要行 LC 的复杂病例为 61 例（61/111，55%）。急性胆囊炎（26/61，42.7%）是最常见的胆囊结石症状。大多数复杂病例发生在术后 1 年随访期（52/61，85%）。在延迟 LC 组（61 例）中，手术时间为 50.13±1.99 分钟，2 例（2/61，3.2%）中转开腹，4 例（4/61，6.4%）发生早期术后并发症，术后再次介入治疗的原因是胆漏和胆囊动脉出血（2/61，3.2%）。
SG 联合 LC 延长了手术时间和住院时间，但围手术期并发症与延迟 LC 相同；SG 联合 LC 可最大限度地减少二次手术的需求。SG 联合 LC 是安全的。
