Ursodeoxycholic Acid for 6 Months After Bariatric Surgery Is Impacting Gallstone Associated Morbidity in Patients with Preoperative Asymptomatic Gallstones
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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.
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.
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.
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.
KeywordsCholelithiasis Ursodeoxycholic acid Asymptomatic gallstones Weight loss Concomitant cholecystectomy
Body mass index
Excess weight loss
Roux-en-Y gastric bypass
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
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 was obtained for all individual participants included in the study.
- 1.Weinsier RL, Ullmann DO. Gallstone formation and weight loss. Obes Res. 1993;1(1):51–6.Google Scholar
- 2.Bonfrate L, Wang DQ, Garruti G, et al. Obesity and the risk and prognosis of gallstone disease and pancreatitis. Best Pract Res Clin Gastroenterol. 2014;28(4):623–35.Google Scholar
- 3.Iglezias Brandao de Oliveira C, Adami Chaim E, da Silva BB. Impact of rapid weight reduction on risk of cholelithiasis after bariatric surgery. Obes Surg. 2003;13(4):625–8.Google Scholar
- 4.D’Hondt M, Sergeant G, Deylgat B, et al. Prophylactic cholecystectomy, a mandatory step in morbidly obese patients undergoing laparoscopic roux-en-Y gastric bypass? J Gastrointest Surg. 2011;15(9):1532–6.Google Scholar
- 5.Nougou A, Suter M. Almost routine prophylactic cholecystectomy during laparoscopic gastric bypass is safe. Obes Surg. 2008;18(5):535–9.Google Scholar
- 6.Worni M, Guller U, Shah A, et al. Cholecystectomy concomitant with laparoscopic gastric bypass: a trend analysis of the nationwide inpatient sample from 2001 to 2008. Obes Surg. 2012;22(2):220–9.Google Scholar
- 7.Runkel N, Colombo-Benkmann M, Huttl TP, et al. Evidence-based German guidelines for surgery for obesity. Int J Color Dis. 2011;26(4):397–404.Google Scholar
- 8.Magouliotis DE, Tasiopoulou VS, Svokos AA, et al. Ursodeoxycholic acid in the prevention of gallstone formation after bariatric surgery: an updated systematic review and meta-analysis. Obes Surg. 2017;27(11):3021–30.Google Scholar
- 9.Conley A, Tarboush M, Manatsathit W, et al. Do gallstones found before sleeve gastrectomy behave the same as those formed after surgery due to weight loss? Am J Surg. 2016;212(5):931–4.Google Scholar
- 10.AWMF Guideline Surgery for obesity and metabolic disorders. 2018. http://www.awmf.org/leitlinien/detail/ll/088-001.html. Accessed 07 Sep 2018.
- 11.Stampfer MJ, Maclure KM, Colditz GA, et al. Risk of symptomatic gallstones in women with severe obesity. Am J Clin Nutr. 1992;55(3):652–8.Google Scholar
- 12.Yardimci S, Coskun M, Demircioglu S, et al. Is concomitant cholecystectomy necessary for asymptomatic cholelithiasis during laparoscopic sleeve gastrectomy? Obes Surg. 2018;28(2):469–73.Google Scholar
- 13.Worobetz LJ, Inglis FG, Shaffer EA. The effect of ursodeoxycholic acid therapy on gallstone formation in the morbidly obese during rapid weight loss. Am J Gastroenterol. 1993;88(10):1705–10.Google Scholar
- 14.Ellner SJ, Myers TT, Piorkowski JR, et al. Routine cholecystectomy is not mandatory during morbid obesity surgery. Surg Obes Relat Dis. 2007;3(4):456–60.Google Scholar
- 15.Tucker ON, Fajnwaks P, Szomstein S, et al. Is concomitant cholecystectomy necessary in obese patients undergoing laparoscopic gastric bypass surgery? Surg Endosc. 2008;22(11):2450–4.Google Scholar
- 16.Abdallah E, Emile SH, Elfeki H, et al. Role of ursodeoxycholic acid in the prevention of gallstone formation after laparoscopic sleeve gastrectomy. Surg Today. 2017;47(7):844–50.Google Scholar
- 17.Adams LB, Chang C, Pope J, et al. Randomized, prospective comparison of ursodeoxycholic acid for the prevention of gallstones after sleeve gastrectomy. Obes Surg. 2015;26(5):990–4.Google Scholar
- 18.Coupaye M, Calabrese D, Sami O, et al. Evaluation of incidence of cholelithiasis after bariatric surgery in subjects treated or not treated with ursodeoxycholic acid. Surg Obes Relat Dis. 2017;13(4):681–5.Google Scholar
- 19.Fobi M, Lee H, Igwe D, et al. Prophylactic cholecystectomy with gastric bypass operation: incidence of gallbladder disease. Obes Surg. 2002;12(3):350–3.Google Scholar
- 20.Aidonopoulos AP, Papavramidis ST, Zaraboukas TG, et al. Gallbladder findings after cholecystectomy in morbidly obese patients. Obes Surg. 1994;4(1):8–12.Google Scholar
- 21.Warschkow R, Tarantino I, Ukegjini K, et al. Concomitant cholecystectomy during laparoscopic Roux-en-Y gastric bypass in obese patients is not justified: a meta-analysis. Obes Surg. 2013;23(3):397–407.Google Scholar
- 22.Altieri MS, Yang J, Nie L, et al. Incidence of cholecystectomy after bariatric surgery. Surg Obes Relat Dis. 2018;14(7):992–6.Google Scholar
- 23.Wanjura V, Szabo E, Osterberg J, et al. Morbidity of cholecystectomy and gastric bypass in a national database. Br J Surg. 2018;105(1):121–7.Google Scholar
- 24.Chen YK, Yeh JH, Lin CL, et al. Cancer risk in patients with cholelithiasis and after cholecystectomy: a nationwide cohort study. J Gastroenterol. 2014;49(5):923–31.Google Scholar
- 25.Wang W, Wang J, Li J, et al. Cholecystectomy damages aging-associated intestinal microbiota construction. Front Microbiol. 2018;9:1402.Google Scholar