Prevalence of gallstones in 1,229 patients submitted to surgical laparoscopic treatment of GERD and esophageal achalasia: associated cholecystectomy was a safe procedure

Abstract

BackgroundAssociation between esophageal achalasia/ gastroesophageal reflux disease (GERD) and cholelithiasis is not clear. Epidemiological data are controversial due to different methodologies applied, the regional differences and the number of patients involved. Results of concomitant cholecistectomy associated to surgical treatment of both diseases regarding safety is poorly understood.AimTo analyze the prevalence of cholelithiasis in patients with esophageal achalasia and gastroesophageal reflux submitted to cardiomyotomy or fundoplication. Also, to evaluate the safety of concomitant cholecistectomy.MethodsRetrospective analysis of 1410 patients operated from 2000 to 2013. They were divided into two groups: patients with GERD submitted to laparocopic hiatoplasty plus Nissen fundoplication and patients with esophageal achalasia to laparoscopic cardiomyotomy plus partial fundoplication. It was collected epidemiological data, specific diagnosis and subgroups, the presence or absence of gallstones, surgical procedure, operative and clinical complications and mortality. All groups/subgroups were compared.ResultsFrom 1,229 patients with GERD or esophageal achalasia, submitted to laparoscopic cardiomyotomy or fundoplication, 138 (11.43%) had cholelitiasis, occurring more in females (2.38:1) with mean age of 50,27 years old. In 604 patients with GERD, 79 (13,08%) had cholelitiasis. Lower prevalence occurred in Barrett's esophagus patients 7/105 (6.67%) (p=0.037). In 625 with esophageal achalasia, 59 (9.44%) had cholelitiasis, with no difference between chagasic and idiopathic forms (p=0.677). Complications of patients with or without cholecystectomy were similar in fundoplication and cardiomyotomy (p=0.78 and p=1.00).There was no mortality or complications related to cholecystectomy in this series.ConclusionsPrevalence of cholelithiasis was higher in patients submitted to fundoplication (GERD). Patients with chagasic or idiopatic forms of achalasia had the same prevalence of cholelithiasis. Gallstones occurred more in GERD patients without Barrett's esophagus. Simultaneous laparoscopic cholecystectomy was proved safe.

Comparative Analysis of Immunological Profiles in Women Undergoing Conventional and Single-Port Laparoscopic Cholecystectomy

“…According to Giraldo et al 26 , women exhibit a greater immune response, both cell-mediated and humoral, are more resistant to infections, and are more susceptible to autoimmune diseases, probably due to the action of female sex hormones. Trastulli et al 31 reported that uncontrolled hyperinflammatory responses caused by surgical trauma can lead to systemic immunosuppression, increasing postoperative morbidity and mortality.…”

“…Laparoscopic cholecystectomy has become the gold standard for surgical treatment of benign gallbladder disease. The advantages of this procedure compared to laparotomy include smaller incisions, reduced surgical trauma, less postoperative pain, faster recovery times, a shorter hospital stay, and faster return to normal activities and work 1 , 7 , 25 , 26 . The use of a single umbilical incision for gallbladder removal was an interesting innovation and single-incision laparoscopic cholecystectomy has gained momentum in the literature since its description by Navarra et al 21 .…”

The Lowest Prevalence of Cholelithiasis in the Americas - An Autopsy-based Study

“…Among the 446 individuals studied, 26% (116) died naturally. In this group, 56% (65) were male, 71% (82) were non-white, and 20% 23 used alcohol. This population was thin (mean BMI 24.29±5.42) and older than the people in the violent death group (65 men, average age ± standard deviation 53.86±17.52 years, and 51 women, average age 54.27±18.6 years).…”

“…In Brazil, studies of autopsy results in people over 20 years of age have reported a prevalence of cholelithiasis of 9.07% in Triângulo Mineiro/MG 7 , 11.7% in Campinas/SP 21 and 19.3% in São Paulo/SP 8 , whereas studies using ultrasound found values of 9.3% in Curitiba/PR 12 and 18.4% in the state of Maranhão 22 . The most recent data from Brazil reported a prevalence of cholelithiasis of 11.43% based on ultrasound evaluations, although the study included patients with GERD (gastroesophageal reflux disease) and esophageal achalasia 23 . Regarding other countries in the Americas, studies of autopsy results found a prevalence of cholelithiasis of 9.1% in Chicago, USA 2 ; 14.3% in Mexico 3 ; and 26.6% in Santiago, Chile 4 , whereas studies using ultrasonography found values of 28.5% in Chile 11 and 20.5% 10 and 21.9% 24 in Argentina and, in the USA, the prevalence was 5.3% and 13.9% in non-Hispanic black men and women, respectively, the ethnic group with the lowest prevalence 1 .…”

Cholelithiasis prevalence and risk factors in individuals with severe or profound intellectual and motor disabilities

“…Regarding enteral nutrition, gastrostomy and fundoplication did not significantly correlate between the groups. However, vagal nerve damage due to fundoplication is involved in gallstone formation (Stahlgren et al 1980;Sallum et al 2015), and further investigation is warranted. No significant association was found between constipation and its management in the present study.…”