Safety of concomitant cholecystectomy at the time of laparoscopic sleeve gastrectomy: analysis of the American College of Surgeons National Surgical Quality Improvement Program database

Dakour-Aridi, Hanaa; El-Rayess, Hebah M.; Abou‐Abbass, Hussein; Abu‐Gheida, Ibrahim; Habib, Robert H.; Safadi, Bassem Y.

doi:10.1016/j.soard.2016.12.012

Cited by 28 publications

(26 citation statements)

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“…Cholestasis due to decreased gallbladder contraction is considered to be the major mechanism of gallstone formation after gastric cancer surgery. [10][11][12][13][14][15][16] Therefore, we excluded patients with a body mass index greater than 37 because of the rapid weight loss expected after surgery. Although bariatric surgical procedures include several other types of surgery (ie, vertical banded gastroplasty and gastric bypass surgery) besides gastrectomy, all surgical procedures for patients with gastric cancer are gastrectomies.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and Safety of Ursodeoxycholic Acid for the Prevention of Gallstone Formation After Gastrectomy in Patients With Gastric Cancer

et al. 2020

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Double-blind, Placebo-controlled Study (PEGASUS-D) Group IMPORTANCE The incidence of gallstones has been reported to increase after gastrectomy. However, few studies have been conducted on the prevention of gallstone formation in patients who have undergone gastrectomy. OBJECTIVE To evaluate the efficacy and safety of ursodeoxycholic acid (UDCA) in preventing gallstone formation after gastrectomy in patients with gastric cancer. DESIGN, SETTING, AND PARTICIPANTS The PEGASUS-D study (Efficacy and Safety of DWJ1319 in the Prevention of Gallstone Formation after Gastrectomy in Patient with Gastric Cancer: A Multicenter, Randomized, Double-blind, Placebo-controlled Study) was a randomized, double-blind, placebo-controlled clinical trial conducted at 12 institutions in the Republic of Korea. Adults (aged Ն19 years) with a diagnosis of gastric cancer who underwent total, distal, or proximal gastrectomy were enrolled between May 26, 2015, and January 9, 2017; follow-up ended January 8, 2018. Efficacy was evaluated by both the full analysis set, based on the intention-to-treat principle, and the per-protocol set; full analysis set findings were interpreted as the main results. INTERVENTIONS Eligible participants were randomly assigned to receive 300 mg of UDCA, 600 mg of UDCA, or placebo at a ratio of 1:1:1. Ursodeoxycholic acid and placebo were administered daily for 52 weeks. MAIN OUTCOMES AND MEASURES Gallstone formation was assessed with abdominal ultrasonography every 3 months for 12 months. Randomization and allocation to trial groups were carried out by an interactive web-response system. The primary end point was the proportion of patients developing gallstones within 12 months after gastrectomy. RESULTS A total of 521 patients (175 received 300 mg of UDCA, 178 received 600 mg of UDCA, and 168 received placebo) were randomized. The full analysis set included 465 patients (311 men; median age, 56.0 years [interquartile range, 48.0-64.0 years]), with 151 patients in the 300-mg group, 164 patients in the 600-mg group, and 150 patients in the placebo group. The proportion of patients developing gallstones within 12 months after gastrectomy was 8 of 151 (5.3%) in the 300-mg group, 7 of 164 (4.3%) in the 600-mg group, and 25 of 150 (16.7%) in the placebo group. Compared with the placebo group, odds ratios for gallstone formation were 0.27 (95% CI, 0.12-0.62; P = .002) in the 300-mg group and 0.20 (95% CI, 0.08-0.50; P < .001) in the 600-mg group. No significant adverse drug reactions were detected among the enrolled patients. CONCLUSIONS AND RELEVANCE Administration of UDCA for 12 months significantly reduced the incidence of gallstones after gastrectomy for gastric cancer. These findings suggest that UDCA administration prevents gallstone formation after gastrectomy in patients with gastric cancer.

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Section: Discussionmentioning

confidence: 99%

“…12 In addition, nonphysiological reconstruction of the gastrointestinal tract 13,14 and an altered response to and secretion of cholecystokinin 15 are possible mechanisms of gallstone formation. Cholestasis due to decreased gallbladder contraction 16 for various reasons can be summarized as the main mechanism of gallstone formation after gastrectomy.…”

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confidence: 99%

Efficacy and Safety of Ursodeoxycholic Acid for the Prevention of Gallstone Formation After Gastrectomy in Patients With Gastric Cancer

et al. 2020

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“…When complications were individually compared, patients who underwent concomitant LC had higher rates of pneumonia and bleeding. e reason for performing LC was not stated in the NSQIP database [15]. We did not report any cases of postoperative pneumonia, deep venous thrombosis, bleeding, or mortality during our study.…”

Section: Scott Et Al Reported That An Advantage Of Delayed Lc Ismentioning

confidence: 95%

“…ey also reported that in minimally symptomatic patients, either delayed or concomitant LC is acceptable, based on patient symptoms and time to elective bariatric surgery, because of the observed low long-term morbidity in several studies as well as acceptable operative time without increasing the length of hospital stay [18]. Dakour-Aridi et al [15] added 33 minutes for LC and Wood et al [19] added 27 and 28 minutes during LSG and OAGB/MGB, respectively. In our study, the mean operative time added for LC was 24 minutes which was less, and this may be explained by the selection of technically easier LC according to LC difficulty score.…”

Section: Scott Et Al Reported That An Advantage Of Delayed Lc Ismentioning

confidence: 99%

Concomitant versus Delayed Cholecystectomy in Bariatric Surgery

et al. 2021

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Background. Obesity and weight loss after bariatric surgery have a close association with gallbladder disease. The performance and proper timing of laparoscopic cholecystectomy (LC) with bariatric surgery remain a clinical question. Objective. Evaluation of the outcome of LC during bariatric surgery whether done concomitantly or delayed according to the level of intraoperative difficulty. Methods. The prospective study included patients with morbid obesity between December 2018 and December 2019 with preoperatively detected gallbladder stones. According to the level of difficulty, patients were allocated into 2 groups: group 1 included patients who underwent concomitant LC during bariatric surgery, and group 2 included patients who underwent delayed LC after 2 months. In group 1, patients were further divided into subgroups: LC either at the beginning (subgroup A) or after bariatric surgery (subgroup B). Results. Operative time in group 1 vs. 2 was 92.63 ± 28.25 vs. 68.33 ± 17.49 ( p < 0.001 ), and in subgroup A vs. B, it was 84.19 ± 19.62 vs. 130.0 ± 31.62 ( p < 0.001 ). One patient in each group (2.6% and 8.3%) had obstructive jaundice, p > 0.001 . In group 2, 33% of asymptomatic patients became symptomatic for biliary colic p > 0.001 . LC difficulty score was 2.11 ± 0.70 vs. 5.66 ± 0.98 in groups 1 and 2, respectively, p < 0.001 . LC difficulty score decreased in group 2 from 5.66 ± 0.98 to 2.26 ± 0.78 after 2 months of bariatric surgery, p < 0.001 . Conclusion. Timing for LC during bariatric surgery is challenging and should be optimized for each patient as scheduling difficult LC to be performed after 2 months may be an option.

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“…The risk of comorbidities such as chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) is higher in obese patients. Obesity is also an independent risk factor for gallstones [2, 3]. In obese patients, gallstone is more symptomatic than in non-obese people [4].…”

Section: Introductionmentioning

confidence: 99%

The effect of concomitant cholecystectomy and sleeve gastrectomy on morbidity in high-risk obese patients with symptomatic gallstones.

Dincer¹,

Dogan²

2019

Videosurgery and Other Miniinvasive Techniques

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Introduction Obesity is an independent risk factor for gallstones. In obese patients, gallstone is more symptomatic than in non-obese people. Aim To present the early results of laparoscopic sleeve gastrectomy (LSG) and concomitant cholecystectomy (CC) performed in patients with symptomatic gallstone accompanied by at least one additional systemic disease to obesity and to investigate its effect on morbidity. Material and methods Patients undergoing sleeve gastrectomy for morbid obesity between January 2016 and August 2018 were retrospectively studied. Twenty-seven patients who underwent laparoscopic sleeve gastrectomy and concomitant cholecystectomy due to symptomatic gallstone stones were included in this study. The patients were divided into two groups according to the applied surgical technique: laparoscopic sleeve gastrectomy and concomitant cholecystectomy (n = 27) and laparoscopic sleeve gastrectomy (n = 70). The results of an additional operation on these patients and their perioperative complications were evaluated. Results A total of 97 patients were included in the study. The mean age of the patients was 40.58 ±10.36 years. There was no statistically significant difference between groups in terms of complications (p = 0.669). The difference in the duration of the operation was statistically significant (p < 0.001). Conclusions Concomitant cholecystectomy may be presented as an alternative surgical procedure due to the demonstration that concomitant cholecystectomy can be performed safely in comorbid obese patients, with a risk of becoming symptomatic in the rest of life at a certain rate, and low risk of complications in asymptomatic patients.

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Safety of concomitant cholecystectomy at the time of laparoscopic sleeve gastrectomy: analysis of the American College of Surgeons National Surgical Quality Improvement Program database

Cited by 28 publications

References 28 publications

Efficacy and Safety of Ursodeoxycholic Acid for the Prevention of Gallstone Formation After Gastrectomy in Patients With Gastric Cancer

Efficacy and Safety of Ursodeoxycholic Acid for the Prevention of Gallstone Formation After Gastrectomy in Patients With Gastric Cancer

Concomitant versus Delayed Cholecystectomy in Bariatric Surgery

The effect of concomitant cholecystectomy and sleeve gastrectomy on morbidity in high-risk obese patients with symptomatic gallstones.

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