Colecistolitíase em pacientes submetidos à derivação gástrica em Y de Roux com anel: estudo prospectivo

Abstract

INTRODUCTION: Obesity is growing at an alarming rate and so the number of operations to treat it. Both obesity and rapid weight loss are related to gallstone formation. Roux-en-Y gastric bypass with ring (RYGB) is a widespread bariatric procedure that carries significant incidence of postoperative cholecystolithiasis (CL). Controversy exists regarding the best approach to gallstones in these patients. Three therapeutic modalities stand out: the first one advocates prophylactic removal of allgallbladders during gastric bypass, the second one selectively removes only gallbladders with stones and the last one proposes cholecystectomy only for patients with symptomatic gallstones. In this study we evaluated the preoperative prevalence of gallstones in patients undergoing RYGB and its incidence after intervention. In addition we tried to identify predictors of its development and the proportion of symptomatic patients among those who formed gallstones. METHODS: It is a prospective, observational study on forty patients undergoing open RYGB. They werefollowed up with clinical exam, laboratory exams (lipid profile) and ultrasonography with 6 months, 1, 2 and 3 years after RYGB. Thirty-eight patients ended the follow up and were divided in two groups, those who formed and those who did not form gallstones. These groups were compared in relation to gender, age, body mass index (BMI), preoperative lipid profile, percentage of BMI loss and postoperative lipid profile. RESULTS: The incidence of CL after the intervention was 28.9% (11/38), the incidence of symptomatic CL was 15,7% (6/38), there was no evidence of predictive factors for CL in this study. Most of the patients who formed gallstones were symptomatic, some with potentially severe complications CONCLUSIONS: Cholecystolithiasis has high incidence after RYGB, occurring basically in the first two years postoperatively. Gender, age, BMI, preoperative lipid profile, PBIVIIL and postoperative lipid profile were not significantly related to CL.