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Ursodeoxycholic Acid for 6 Months After Bariatric Surgery Is Impacting Gallstone Associated Morbidity in Patients with Preoperative Asymptomatic Gallstones

  • Andrea Della Penna
  • Jessica Lange
  • Julia Hilbert
  • Rami Archid
  • Alfred Königsrainer
  • Markus QuanteEmail author
Original Contributions
  • 59 Downloads

Abstract

Background

Obesity is a predisponing factor for gallstone formation with a prevalence > 10% in patients undergoing gastric bypass procedure. Although there is a strong recommendation for concomitant cholecystectomy in patients with symptomatic gallstones, the evidence level for patients with asymptomatic gallstones is weak. According to recent literature, up to 21% of asymptomatic gallstones become symptomatic after bariatric surgery. Secondary prophylaxis with ursodeoxycholic acid (UDCA), which is altering the composition and excretion of the bile acid pool, was the objective of this study.

Methods

Retrospective analysis of the patient records of all patients undergoing laparoscopic Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SGx) at our center between January 2007 and October 2017.

Results

We enrolled a total of 704 patients with routine preoperative ultrasound. In 61 patients, asymptomatic gallstones were detected and these patients were treated with UDCA for 6 months after bariatric surgery. One patient developed a single episode of symptoms 3 months after SGx, which did not require surgery. One patient developed chronic cholecystitis and underwent cholecystectomy 6 months after SGx. All other patients (n = 59; 96.8%) remained asymptomatic under UDCA therapy.

Conclusion

UDCA for 6 months after bariatric surgery seems to reduce the incidence of gallstone-associated morbidity when compared to the current literature. Thus, our results call the concept of prophylactic concomitant cholecystectomy in patients with asymptomatic gallstones into question while at the same time paving the way for a future clinical trial.

Keywords

Cholelithiasis Ursodeoxycholic acid Asymptomatic gallstones Weight loss Concomitant cholecystectomy 

Abbreviations

BMI

Body mass index

EWL

Excess weight loss

RYGB

Roux-en-Y gastric bypass

SGx

Sleeve gastrectomy

UDCA

Ursodeoxycholic acid

US

Ultrasonography

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained for all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General, Visceral and Transplant SurgeryUniversity Hospital TübingenTübingenGermany

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