Intraoperative Ultrasound and Prophylactic Ursodiol for Gallstone Prevention Following Laparoscopic Gastric Bypass

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2003 Sep 6

PMID 12958683

Citations 19

Authors

D J Scott

L Villegas

T L Sims

E C Hamilton

D A Provost

D B Jones

Affiliations

Soon will be listed here.

Abstract

Background: Previous studies have shown that ursodiol decreases gallstone formation from 32% to 2% following open gastric bypass, but no data exist on laparoscopic Roux-en-Y gastric bypass (LRYGB) using intraoperative ultrasound (IOUS) screening.

Methods: LRYGB with IOUS were performed on 195 consecutive patients. Patients with gallstones underwent simultaneous cholecystectomy, and patients without gallstones were prescribed ursodiol, 300 mg twice daily, for 6 month. Follow-up survey and ultrasound.

Results: Of 195 patients, 44 (23%) had had a prior cholecystectomy, 21 (11%) underwent a simultaneous cholecystectomy, 129 (66%) had gallbladders left intact, and one (0.5%) false negative IOUS was excluded. Of 69 patients with ultrasound and survey follow-up (mean, 10 months), 19 (28%) developed gallstones seven with symptoms), and 50 (72%) were gallstone free. Forty-one percent of patients were compliant with ursodiol. There was no difference in compliance between patients with and without gallstones. In patients with gallstones, all of the symptomatic patients were noncompliant, whereas none of the compliant patients developed symptoms. Medication side-effects occurred in 17 of 69 patients (25%).

Conclusions: IOUS during LRYGB efficiently screens for gallstones, and selective cholecystectomy followed by prophylactic ursodiol results in low morbidity. Improvements in compliance may lower the incidence of postoperative gallstone formation.

Citing Articles

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Analysis of the Management of Cholelithiasis in Bariatric Surgery Patients: a Single-Center Experience.

Petrola Chacon C, Vilallonga R, Gonzalez Lopez O, de Gordejuela A, Beisani M, Caubet Busquet E Obes Surg. 2022; 32(3):704-711.

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Concomitant versus Delayed Cholecystectomy in Bariatric Surgery.

Elgohary H, El Azawy M, Elbanna M, Elhossainy H, Omar W J Obes. 2021; 2021:9957834.

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Asymptomatic Cholelithiasis and Bariatric Surgery: a Comprehensive Long-Term Analysis of the Risks of Biliary Disease in Patients Undergoing Primary Roux-en-Y Gastric Bypass.

Cunningham R, Jones K, Kuhn J, Dove J, Horsley R, Daouadi M Obes Surg. 2020; 31(3):1249-1255.

PMID: 33230759 DOI: 10.1007/s11695-020-05125-8.

Incidence and Risk Factors for Cholelithiasis After Bariatric Surgery.

Guzman H, Sepulveda M, Rosso N, San Martin A, Guzman F, Guzman H Obes Surg. 2019; 29(7):2110-2114.

PMID: 31001756 DOI: 10.1007/s11695-019-03760-4.

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