Incidence of cholelithiasis after laparoscopic Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus with obesity

Abstract

Objective To investigate the incidence of cholelithiasis after laparoscopic Roux-en-Y gastric bypass(LRYGB) for treatment of type 2 diabetes mellitus with obesity. Methods The clinical data of 89 obese patients with type 2 diabetes mellitus who underwent LRYGB at the Sixth People's Hospital Affiliated to Shanghai Jiaotong University from March 2011 to March 2013 were retrospectively analyzed. Sixty-six patients without postoperative gallstone and sludge were divided into the normal group and 23 with postoperative gallstone or sludge into the gallstone group. The waistline, hipline, body weight, body mass index(BMI), excess weight loss (EWL), fasting blood glucose, postprandial 2-hour blood glucose, glycosylated hemoglobin (HbAlc), homeostasis model assessment-insulin resistance (HOMA-IR), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), serum total bile acid at postoperative month 6, 12, 24 were analyzed. The patients were followed up by inpatient, outpatient examination and telephone interview till April 2015. Measurement data with normal distribution were presented as ±s, comparison between groups and repeated measures data were analyzed using the t test and repeated measures ANOVA, respectively. Count data were analyzed by the chi-square test. Results All the 89 patients underwent successful LRYGB and were followed up for 31 months (range, 24-48 months). The EWL, HbAlc and serum total bile acid at postoperative month 6, 12, 24 were 113%±43%, 117%±64%, 119%±84% and 6.1%±0.8%, 6.2%±1.1%, 6.4%±1.0% and (4.6±3.8)μmol/L, (4.5±3.6)μmol/L, (4.6±3.8)μmol/L in the normal group and 157%±96%, 152%±102%, 151%±93% and 5.9%±0.8%, 5.8%±0.6%, 5.9%±0.8% and (23.9±9.0)μmol/L, (11.8±7.3)μmol/L, (10.5±9.6)μmol/L in the gallstone group, respectively, showing significant differences in changing trend between the 2 groups (F=6.896, 5.226, 5.351, P<0.05). There were significant differences in the EWL at postoperative month 6, 12, 24 between the 2 groups (t=2.814, 2.628, 2.099, P<0.05). There were significant differences in the HbAlc at postoperative month 12 and serum total bile acid at postoperative month 6, 24 between the 2 groups (t=2.018, -1.378, -1.990, P<0.05). Conclusion There is incidence risk of cholelithiasis after LRYGB in obese patients with type 2 diabetes mellitus. The rapid decreasing of weight is associated with cholelithiasis in which patients have higher level of serum bile acid. Key words: Diabetes mellitus, type 2; Obesity; Cholelithiasis; Gastric bypass; Laparoscopy