Background
Currently, laparoscopic sleeve gastrectomy (LSG) is one of the most common bariatric surgeries. Concomitant cholecystectomy is routinely performed for symptomatic patients. However, the management of patients with asymptomatic gallstones is still controversial. Again, the incidence, the prospective presentation of postoperative cholelithiasis in patients without previous gallstones disease is also deficient and unpredictable.
Patients and methods
This prospective study included 95 patients with asymptomatic gallstone disease (group A) and 755 patients without gallstone disease (group B) who underwent LSG. The endpoint was the development of symptomatic gallstones requiring surgical intervention. Types of presentation, relevant preoperative workup, and operative and postoperative findings were reported.
Results
In groups A and B, the mean age was 35.6±7.6 and 35.34±7.7 years; the preoperative BMI was 39.4±1.02 and 40.3±0.76 kg/m; the percentage of excess weight loss was 50±2.54% and 67±2.8% at the time of presentation, and 67.4 and 71.3% patients were women, respectively. Symptomatic gallstones were found in 17 (18%) patients in group A, two of whom had acute presentation. Two hundred and eighteen (29%) patients in group B had newly developed symptomatic gallstones, 35 (16%) of whom had acute presentation; two of them showed obstructive biliary symptoms. The time of presentation was significantly different between the two groups (group A: 10.5±1.7 months; group B: 21±6.6 months; =0.0001). The mean follow-up periods were 26±9 and 28±12 months in groups A and B, respectively. Our results showed a high incidence of symptomatic gallstone after LSG. Family history and percentage of excess weight loss were also significantly correlated with symptom development. No operative difficulties were encountered in any patients, and no conversion occurred in our study.
Conclusion
Symptomatic cholelithiasis can present soon after sleeve gastrectomy and may warrant surgical intervention. A significant number of preoperatively healthy patients develop gallstones, with acute presentation in some cases. Although no consensus on concomitant cholecystectomy for treating asymptomatic patients has been reached, we found this procedure mandatory for high-risk patients.