Concomitant versus Delayed Cholecystectomy in Morbidly Obese Patients with Asymptomatic Gall Stones Undergoing Laparoscopic Sleeve Gastrectomy (original) (raw)
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Concomitant cholecystectomy during laparoscopic sleeve gastrectomy
Surgical Endoscopy, 2014
Background The prevalence of cholelithiasis in morbidly obese individuals is 19-45 %. Laparoscopic sleeve gastrectomy (LSG) has become one of the most performed procedures worldwide. The management of gallstones at the time of LSG is under debate. We herein report our experience with concomitant LSG and cholecystectomy. Methods Patients undergoing LSG, between 2006 and 2014 with symptomatic cholelithiasis (SC), underwent concomitant cholecystectomy (SGC), and were compared to those who had LSG alone. Gender, age, and BMI were noted. Preoperative ultrasonography was performed for all patients and gallstone presence was recorded. Operative time, intraoperative mishaps, perioperative complications, length of hospital stay (LOS), and the incidence of subsequent symptomatic gallbladder disease were collected as well.
Complicated Gallstones after Laparoscopic Sleeve Gastrectomy
Journal of Obesity, 2014
Background. The natural history of gallstone formation after laparoscopic sleeve gastrectomy (LSG), the incidence of symptomatic gallstones, and timing of cholecystectomy are not well established. Methods. A retrospective review of prospectively collected database of 150 patients that underwent LSG was reviewed. Results. Preoperatively, gallbladder disease was identified in 32 of the patients (23.2%). Postoperatively, eight of 138 patients (5.8%) became symptomatic. Namely, three of 23 patients (13%) who had evident cholelithiasis preoperatively developed complicated cholelithiasis. From the cohort of patients without preoperative cholelithiasis, five of 106 patients (4.7%) experienced complicated gallstones after LSG. Total cumulative incidence of complicated gallstones was 4.7% (95% CI: 1.3-8.1%). The gallbladder disease-free survival rate was 92.2% at 2 years. No patient underwent cholecystectomy earlier than 9 months or later than 23 months indicating the post-LSG effect. Conclusion. A significant proportion of bariatric patients compared to the general population became symptomatic and soon developed complications after LSG, thus early cholecystectomy is warranted. Routine concomitant cholecystectomy could be considered because the proportion of patients who developed complications especially those with potentially significant morbidities is high and the time to develop complications is short and because of the real technical difficulties during subsequent cholecystectomy.
Gut, 1993
The pre and postoperative symptoms and outcome after surgery in patients with symptomatic gall stone disease were evaluated by a detailed self administered postal questionnaire. The survey was conducted in two groups: 80 patients treated by laparoscopic cholecystectomy and an age matched cohort of patients who had conventional open cholecystectomy. The overall response rate on which the data were calculated was 76%. Symptomatic benefit ratios accruing from the surgical removal ofthe gall bladder were calculated. The symptoms that were relieved by cholecystectomy were nausea (0.98), vomiting (0-91), colicky abdominal pain (0.81), and backpain (0.76). Flatulence, fat intolerance, and nagging abdominal pain were unaffected as shown by a benefit ratio of 0 5 or less. Relief of heartburn (39/49) outweighed the de novo development of this symptom after cholecystectomy (7/49), resulting in a benefit ratio of 0*65. Postcholecystectomy diarrhoea occurred in 21/118 patients (18%): 10 after open cholecystectomy and 11 after laparoscopic cholecystectomy. The type ofsurgical access did not influence the symptomatic outcome but had a significant bearing on the time to return to work or full activity after surgery (laparoscopic cholecystectomy two weeks, open cholecystectomy eight weeks, p=000001). In the elderly age group (>60 years), significantly more patients (29/30) regained full activity after laparoscopic cholecystectomy when compared with the open cholecystectomy group (16/22), p=OOOl. The patient appreciation of a satisfactory cosmetic result was 72% in the open group compared with 100% of patients who were treated by laparoscopic cholecystectomy (p=0 0017). Despite the persistence or de novo occurrence of symptoms, 111/117 patients (95%) considered that they had obtained overall symptomatic improvement by their surgical treatment and 110/118 (93%) were pleased with the end result regardless of the access used.
Should concurrent prophylactic cholecystectomy be performed in laparoscopic sleeve gastrectomy?
Medical journal of islamic world academy of sciences, 2019
The causes of gallstone formation include rapid gain or loss of weight. Not all gallstones become symptomatic. Concurrent cholecystectomy in sleeve gastrectomy remains controversial. This study aimed to investigate whether concurrent cholecystectomy should be performed after sleeve gastrectomy (SG). A total of 268 patients with normal preoperative gallbladder ultrasonography findings, who underwent laparoscopic SG in Ankara Numune Training and Research Hospital between 2011 and 2018, were retrospectively examined. The data collected from 40 patients with symptomatic cholelithiasis during the postoperative follow-up were analyzed. Forty patients [32(80%) female and 8 (20%) male] developed symptomatic cholelithiasis after an average of 10.65 ± 5.98 months of SG and underwent surgery. The mean age of the patients was 38 ± 11 years. The mean body mass index before SG was 48.15 ± 5.61. The mean percentage of excess weight loss was 69.85 ± 17.4 at the time the patients underwent cholecystectomy. As the percentage of excess weight loss increased, the time to the development of postoperative symptomatic cholelithiasis decreased, and this relationship was statistically significant (R = 0.435, P = 0.005). Prophylactic cholecystectomy need not be performed concurrently with SG in patients without preoperative symptomatic gallstones. The reason is that laparoscopic cholecystectomy can be safely performed in the postbariatric surgery period, and the risk of symptomatic gallstone formation depends on individual risk factors.
Prophylactic Cholecystectomy with GastricBypass Operation:Incidenceof GallbladderDisease
Background: Morbid obesity is one of the major risk factors for gallbladder disease, and this risk is even greater following rapid weight loss. Because of this, prophylactic cholecystectomy has been offered to our patients undergoing the transected silastic ring vertical Roux-en-Y gastric bypass (TSRVRYGBP). A study was undertaken to determine the incidence of pathologic gallbladders in patients undergoing this prophylactic cholecystectomy.
A Prospective Study of 100 Consecutive Laparoscopic Cholecystectomies
Annals of International medical and Dental Research, 2017
Background: Cholelithiasis, the leading cause for hospital admissions related to gastrointestinal problems, had been traditionally dealt by open cholecystectomy. Erich Muhe performed the first laparoscopic cholecystectomy on September 12, 1985. In September 1992, a National Institute of Health (NIH) consensus conference held in Bethesda concluded that laparoscopic cholecystectomy should be the treatment of choice for gallstone disease. This study on laparoscopic cholecystectomy was done to illustrate the clinical manifestations and peroperative findings in gallstone disease. Methods: We prospectively studied 100 consecutive cases undergoing laparoscopic cholecystectomy at our institute. Presenting complaints, laboratory investigations and USG findings were noted. Standard 4-port laparoscopic cholecystectomy was performed, with closed method using Veress needle preferred for the first (umbilical) port. All peroperative findings were analyzed. Results: Majority of the patients were female (79%), and the average age of the patients was 40.18 years. Pain in upper abdomen was the most common presenting complaint (93%) and an association with meal was found in 85%. Peroperatively, multiple calculi were found in 77%, with impaction of calculus at neck seen in 10% of the patients. Distended gall bladder was seen in 19%, and mucocele in 3%. Shrunken gall bladder was observed in 4%. Difficult Calot's triangle, due to adhesions, was found in 22%. Biliary tree or vascular anomaly was seen in 8%. Mean postoperative hospital stay was 1.92 days. Conclusion: Pain abdomen in gallstone disease is commonly seen in association with meals. Thick-walled gall bladder, adhesions at Calot's triangle, and distended gall bladder are common peroperative findings.
Is concomitant cholecystectomy with laparoscopic sleeve gastrectomy safe?
The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology, 2014
To study the effect of selective concomitant cholecystectomy (SCC) on laparoscopic sleeve gastrectomy (LSG). A retrospective case-control study of 16 morbidly obese patients treated with concomitant LSG as the primary bariatric surgery and SCC for proven gallbladder (GB) pathology (Group A) between November 2010 and February 2013 was performed. Randomly selected 32 patients who underwent laparoscopic sleeve gastrectomy was the control group (Group B). A total of 48 patients with a mean age of 35.5±10.7 years were included. Demographic data of groups were similar except that there were more female patients in the Group A (p=0.036). Mean body mass index (kg/m2) was 51.1±5.6 and 50.9±5.4 in Groups A and B, respectively (p=0.894). The mean operative time for patients with and without cholecystectomy was 157.2±40 and 95.72±6.2 min, respectively (p=0.001). Cholecystectomy resulted in an additional mean operative time of 49.1±27.9 min without any specific complication. There was no statist...
CHOLECYSTCTOMY DURING LAPAROSCOPIC SLEEVE GASTRECTOMY IN MORBIDLY OBESE PATIENTS.
Laparoscopic cholecystectomy (LC) in bariatric patients may be technically challenging due to suboptimal port placement and difficult body habitus, Often the gallbladder is engulfed by the large liver and is difficult to dissect laparoscopically. The aim of the study is to evaluate Concomitant cholecystectomy and LSG in 18 morbid obese patients with proven gall bladder pathology regarding the intra-operative and early short-term post-operative outcomes. The operative time ranged from 118 to 192 min. with mean duration 151.56 ? 21.11 min. time of cholecystectomy within same operations ranged from 34 to 62 min. with mean duration 47.72 ? 7.87 min. Most of surgeons preferred to start with sleeve gastrectomy leaving cholecystectomy at end of the procedures. One or two additional trocars were placed in the right upper quadrant to complete cholecystectomy during LSG. Concomitant cholecystectomy can be applied to all LSG patients with proven GB pathology. It adds not more than one hour to the operation time without an increase in morbidity or length of hospital stay.
Surgical Endoscopy, 2013
Background The purpose of this study was to compare length of stay, as one of the efficacy indicators, and effectiveness, in terms of operative complications and mortality, between laparoscopic (LC) and open cholecystectomy, and to verify the 10-year temporal trends in the application of the LC technique in a large regional population. Methods This was a retrospective cohort study based on 73,853 hospital discharge records of cholecystectomies for gallstone disease (GD) in residents of the Veneto from 2001 to 2010, at both public and accredited private hospitals. The data are from a regional administrative database. The main epidemiological rates calculated, and expressed per 100,000 residents, were the cholecystectomy rate (CR) for gallstones by surgical technique (laparoscopic or open surgery), and the in-hospital mortality rate (MR), considered as the in-hospital MR regardless of the specific cause of death. Results The CR was 139.7 higher in females, with a male-to-female ratio of 1:1.5. LC was performed more frequently in females than in males and in younger than in older patients. From 2001 to 2010, there was a significant linear rising trend in the use of LC, in fact during the period considered, the use of laparoscopic surgery increased significant (v 2 trend: 316,917; p \ 0.05), reaching 93.6 % of surgical procedures for gallstones during the year 2010. Conclusions There are still some age-and gender-related disparities in its usage, although LC is an increasingly widely applied, as effective procedure.
Background: Gallstone disease is a major health problem worldwide particularly in the adult population. Previously complicated gallstone disease was considered to be a contraindication for laparoscopic cholecystectomy. This initial reluctance has slowly evaporated as a result of increasing expertise. The aim of study was to compare the outcome of laparoscopic with open cholecystectomy in patients with complicated gallstone disease. Material & Methods: This study was carried out in Surgical Unit-IV, Liaquat University Hospital Jamshoro, from January 2008 to December 2009. One hundred patients were divided in two groups of 50 each; Group A for open Cholecystectomy (OC) and group B for laparoscopic cholecystectomy (LC). Data was analyzed using SPSS software. Results: Out of 100 patients there was female preponderance with male to female ratio of 1:1.5 in group A and 1:3.5 group B. The mean age was 41.28±12.30 years for group A and 38.44±13.50 for group B. Ultrasound findings revealed was single stone [13(26%) patients in OC vs 10 (20%) patients in LC group], multiple stones [37(74%) patients in OC vs 40 (48%) patients in LC group], Impacted stone [15(30%) patients in OC vs 18 (36%) patients in LC group], Thick wall gallbladder [26(52%) patients in OC vs 25(50%) patients in LC group], empyma [6(12%) patients in OC vs 8(16%) patients in LC group], mucocele [3(6%) patients in OC vs 5(10%) patients in LC group], contracted [7(14%) patients in OC vs 8(16%) patients in LC group]. Operative time range 30 minutes to 90 minutes in both groups. The mean time in OC group was 54.90±15.90 minutes and LC group was 48.30±12.96 minutes (p 0.026). No mortality was reported in this series. Conclusion: Laparoscopic cholecystectomy is a safe and effective treatment of complicated gallstone disease. KEY WORDS: Laparoscopy, Cholecystectomy, Gallstone.