Cholelithiasis after bariatric surgery, incidence, and prophylaxis: randomized controlled trial

Area of Science:

• Bariatric Surgery
• Gastroenterology
• Metabolic Disorders

Background:

• Rapid weight loss, often a consequence of bariatric surgery, is linked to a higher incidence of gallstones (cholelithiasis).
• Understanding gallstone formation post-surgery is crucial for patient management and optimizing outcomes.

Purpose of the Study:

• To determine the incidence of gallstone formation following various weight loss surgeries.
• To evaluate the effectiveness of a 6-month prophylactic regimen of Ursodeoxycholic acid (UDCA) in preventing gallstones.

Main Methods:

• A randomized controlled trial (RCT) involving 1432 patients undergoing laparoscopic one anastomosis gastric bypass (OAGB), sleeve gastrectomy (SG), or greater curve plication (GCP).
• Patients were randomized to receive either UDCA or a placebo for 6 months, with follow-up for at least one year to assess cholelithiasis and weight loss.

Main Results:

• The overall incidence of cholelithiasis was 9.7%, with a significant reduction from 22% in the placebo group to 6.5% in the UDCA-treated group.
• Higher rates of gallstone formation were observed after SG and OAGB compared to GCP.
• Excess weight loss (%EWL) was greater in patients who developed gallstones, particularly after SG and OAGB.

Conclusions:

• Gallstone formation is more prevalent after SG and OAGB than GCP, potentially linked to rapid %EWL.
• A 6-month course of UDCA is an effective short-term prophylaxis against gallstone formation after bariatric surgery.
• UDCA significantly decreases gallstone incidence, with a number needed to treat (NNT) of six.