Cholelithiasis after bariatric surgery, incidence, and prophylaxis: randomized controlled trial
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and Other Interventional Techniques
Cholelithiasis after bariatric surgery, incidence, and prophylaxis: randomized controlled trial Ahmed Talha1 · Tamer Abdelbaki2 · Ayman Farouk1 · Ehab Hasouna3 · Eman Azzam3 · Gihan Shehata4 Received: 11 June 2019 / Accepted: 11 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background Rapid weight loss is associated with a high incidence of cholelithiasis. Objectives To identify the incidence of gallstone formation after weight loss surgery and to detect the efficacy of 6 months regimen of prophylactic Ursodeoxycholic acid (UDCA). Methods RCT included a total of 1530 morbid obese patients who were subjected to either laparoscopic one anastomosis gastric bypass (OAGB), sleeve gastrectomy (SG), or greater curve plication (GCP). Patients with previous or concomitant cholecystectomy and missed follow-up were excluded, leaving 1432 patients to analyze. They were randomly allocated into two groups receiving either UDCA or placebo with a minimum follow-up of one year for assessment of cholelithiasis and weight loss. Results The overall incidence of cholelithiasis after surgery was 9.7%. There was a significant decrease in the incidence of gallstone formation from 22% in placebo to 6.5% in treated group with UDCA. The mean percentage of excess weight loss (%EWL) was significantly higher in those who develop gallstones than others. Of those developing gallstones, there was 64.7 % with SG versus 28.1% and 7.2% in OAGB and GCP, respectively, which is statistically significant. NNT to prevent cholelithiasis is six, AR% is 70.4%, and RR is 3.4%. Conclusions Cholelithiasis after SG and OAGB was higher than GCP. %EWL was rapid and higher in OAGB and SG contributing to the higher rate of symptomatic cholelithiasis and could be predictive for post-bariatric cholelithiasis. A 6-month use of UDCA is an effective prophylaxis decreasing gallstone formation after bariatric surgery at short-term follow-up. Keywords Obesity · Gallstones · Bariatric surgery · Ursodeoxycholic acid Obesity is associated with increased risk for hypertension, diabetes, pulmonary disease, hyperlipidemia, cardiomyopathy, malignancy, arthritis, infertility, sleep apnea, gallstone formation, and psychosocial impairments. Weight loss has been proven to effectively reduce many comorbid conditions * Ahmed Talha [email protected] 1
Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
2
Department of Surgery, Faculty of Medicine, Alexandria University, 165, Horreya Avenue, Hadara, Alexandria 21561, Egypt
3
Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
4
Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
associated with obesity [1] Dietary regimen, behavioral modification, and exercise have been largely unsuccessful in achieving and maintaining long-term results in morbidly obese patients. The
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