Abstract
BackgroundThe frequency of gallstones is higher in patients who have undergone gastrectomy than in the general population. While there have been some studies of gallstone formation after open gastrectomy, there are few reports of gallstones after laparoscopic gastrectomy (LG). Therefore, this study aimed to evaluate the incidence of gallstones after LG.MethodsWe retrospectively reviewed the records of 184 patients who underwent LG between January 2011 and May 2016 at Saiseikai Utsunomiya Hospital. After gastrectomy, abdominal ultrasonography was generally performed every 6 months for 5 years. Patients who underwent cholecystectomy before LG, underwent simultaneous cholecystectomy, and did not undergo abdominal ultrasonography, with an observation period of < 24 months, were excluded from the study. Finally, 90 patients were analyzed. Laparoscopic cholecystectomy was performed whenever biliary complications occurred. Patient characteristics were compared using the two-tailed Fisher’s exact test or Chi-square test. In addition, the risk factors for postoperative gallstones were analyzed using logistic regression analysis.ResultsAmong the 90 patients included in this study, 60 were men (78%), and the mean age was 65.5 years. Laparoscopic total gastrectomy was performed for 15 patients and laparoscopic distal gastrectomy for 75 patients. D2 lymph node dissection was performed for 8 patients (9%), whereas 68 patients underwent LG with Roux-en-Y reconstruction (76%). Gallstones were detected after LG in 27 of the 90 (30%) patients. Multivariate analysis identified Roux-en-Y reconstruction and male sex as significant risk factors of gallstones after gastrectomy. The incidence of gallstones was significantly higher (53%) in male patients who underwent Roux-en-Y reconstruction. Symptomatic gallstones after laparoscopic cholecystectomy were found in 6 cases (6/27, 22%), and all patients underwent laparoscopic cholecystectomy.ConclusionRoux-en-Y reconstruction and male sex were identified as significant risk factors for gallstones after LG.
Highlights
The frequency of gallstones is higher in patients who have undergone gastrectomy than in the general population
Based on low-quality evidence, there is no difference in short-term mortality between laparoscopic gastrectomy (LG) and open gastrectomy, and there is no evidence for any difference in short-term and long-term outcomes
The patients had been treated by laparoscopic total gastrectomy (LTG) or laparoscopic distal gastrectomy (LDG) with lymph node dissection and tumor–node–metastasis staging, following the guidelines of the Japanese Classification of Gastric Carcinoma (3rd English edition) and the Japanese Gastric Cancer Treatment Guidelines [10, 11]
Summary
While there have been some studies of gallstone formation after open gastrectomy, there are few reports of gallstones after laparoscopic gastrectomy (LG). The frequency of gallstones is higher in patients who have undergone gastrectomy than in the general population (6.5–25% vs 2.2–5.0%) [1,2,3,4,5,6,7]. While there have been some studies of gallstone formation after open gastrectomy, there are few reports of gallstones after LG. Our retrospective study analyzed the frequencies and risk factors for gallstones in patients who had undergone LG for gastric cancer
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