Abstract
Aims Obese patients are at increased risk for gallstones during rapid weight loss and after laparoscopic sleeve gastrectomy. The aims of this study were to evaluate the prophylactic effect of ursodeoxycholic acid and ezetimibe for prevention of gallstone formation after sleeve gastrectomy and to identify some risk factors. Settings and design This was a prospective randomized study conducted at Al Rashid Hospital, Kuwait. Patients and methods A total of 215 obese patients were included. Preoperative assessment was performed, including history, examination, obesity evaluation (body weight, BMI, waist circumference), full laboratory work, gastroscopy, and abdominal ultrasonography. After laparoscopic sleeve gastrectomy, patients were divided randomly into: group 1 (control), group 2 (ursodeoxycholic acid), and group 3 (ezetimibe). Patients were scheduled for 3-, 6-, and 12-month visits for assessment of % excess weight loss and abdominal ultrasonography. Results A significant reduction in gallstone formation was found in the ezetimibe group (5.5%) compared with the control group (17.6%). A statistically significant increase in % excess weight loss was observed in patients with gallstones (38.5%) versus patients without gallstones (28.2%). Percentage of gallstone formation during first 6 months postoperatively was double that during the next 6 months in both the control and treatment groups. Conclusion Risk of gallstone formation during the first 6 months after laparoscopic sleeve gastrectomy was double that during the second 6 months. Ezetimibe is effective in reducing relative risk by 70% and ursodeoxycholic acid by 50% versus control; hence, we recommend usage of one of these medications for 1 year postoperatively. Furthermore, we recommend more work on combining both medications together.
Highlights
Obese persons are at risk for cholesterol gallstones because of high saturation of cholesterol in their bile
Patients and methods All patients submitted to laparoscopic sleeve gastrectomy performed between 2009 and 2011 at Al Rashid Hospital were enrolled in the study
A total of 215 patients completed the study, whereas 48 patients were excluded for having history of cholecystectomy, gallstone disease, or they refused to share in the study
Summary
Obese persons are at risk for cholesterol gallstones because of high saturation of cholesterol in their bile. About 75% of gallstones are of cholesterol type. The risk increases during rapid weight loss using low-calorie diets and after bariatric surgery. The mechanism for gallstone formation during rapid weight loss is not completely understood; several mechanisms have been suggested including increased bile cholesterol saturation and gallbladder stasis, increased secretion of mucin and calcium, and increased prostaglandins [1,2,3,4]. To reduce the risk for gallstone formation, policies of prophylactic cholecystectomy are proposed [5].
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