Öz
Aim: 13% of adults are 18 years old and over, and comorbid diseases of obesity are on the increase in the World. Patients that reach
standard weight after bariatric surgery show recovery in comorbid diseases. Gallbladder stone incidence rate increases with obesity.
Development of stone after bariatric surgery is known to be on higher levels, as well. The objective of this study is to analyze the
gallbladder stone and/or complications that may develop after Laparoscopic Sleeve Gastrectomy (LSG) surgery.
Material and Methods: The medical files of 68 patients were retrospectively analyzed, who underwent LSG surgery between January
2013 and December 2016 in Ankara Atatürk Training and Research Hospital.
Results: The age average of female patients that underwent LSG surgery is 42.95±10.72, while it is 36.23±10.76 for male patients. While
the mean BMI (Body Mass Index) of female and male patients were respectively 45.26±3.58 kg/m2 and 47.58±7.74 kg/m2, this mean was
found that BMI levels decreased to 27.18±2.80 kg/m2 for female patients and 27.92±3.79 kg/m2 for male patients (p<0.001). 17 (31%) of
the patients, who underwent LSG surgery suffered from gallbladder stone or sludge. Acute cholecystitis was found in one (5.88%) of the
patients who developed post-operative gallbladder stones. When the patients after LSG surgery were compared in terms of weight loss,
no statistically significant difference was found between those with and without gallstones (p=0.065).
Conclusion: Laparoscopic cholecystectomy (LC) was not required in patients who did not have symptomatic cholelithiasis. The rate
of developing gallbladder stone after LSG surgery was found to be high. However, since these stones do not show any symptoms in the
early period, we think that regular control of LSG patients will decrease the incidence of symptomatic cholelithiasis.
Kaynakça
- 1. World Health Organization. Obesity and overweight [Internet]. 2018 Feb 16; [cited 2018 August 30]. Available from: http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. 2. Republic of Turkey Ministry of Health. The Ministry of Health of Turkey, health statistics year book 2016. Ankara: SB-SAGEM-2017; [cited 2018 August 30]. Available from: http://ohsad.org/wp-content/uploads/2017/12/13160.pdf. 3. Kiriakopoulos A, Varounis C, Tsakayannis D, Linos D. Laparoscopic sleeve gastrectomy in morbidly obese patients. Technique and short term results. Hormones (Athens). 2009 Apr-Jun;8(2):138-43. 4. Eisenberg D, Bellatorre A, Bellatorre N. Sleeve gastrectomy as a stand-alone bariatric operation for severe, morbid, and super obesity. JSLS. 2013 Jan-Mar;17(1):63-7. 5. Al Zabadi H, Daqour A, Hawari A, Hasouni J. Short-term outcomes of laparoscopic sleeve gastrectomy among obesity patients in the Northern West Bank: a retrospective records review. BMC Res Notes. 2014 Feb 7;7:85. 6. Young MT, Gebhart A, Phelan MJ, Nguyen NT. Use and Outcomes of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Gastric Bypass: Analysis of the American College of Surgeons NSQIP. J Am Coll Surg. 2015 May;220(5):880-5. 7. Våge V, Sande VA, Mellgren G, Laukeland C, Behme J, Andersen JR. Changes in obesity-related diseases and biochemical variables after laparoscopic sleeve gastrectomy: a two-year follow-up study. BMC Surg. 2014 Feb 11;14:8. 8. Dittrick GW, Thompson JS, Campos D, Bremers D, Sudan D. Gallbladder pathology in morbid obesity. Obesity Surgery. 2005;15(2):238–242. 9. Eleni S, Dimitris Z, Eleni Z, Dimitris P, Ourania P, Georgia K, George T. Complicated Gallstones after Laparoscopic Sleeve Gastrectomy. Hindawi Publishing Corporation Journal of Obesity Volume 2014, Article ID 468203, 5. 10. Li VK, Pulido N, Fajnwaks P, et al. Erratum to “Predictors of gallstone formation after bariatric surgery: a multivariate analysis of risk factors comparing gastric bypass, gastric banding, and sleeve gastrectomy” Surgical Endoscopy. 2009;23(7):p. 1645. 11. Quesada BM, Kohan G, Roff HE, Canullan CM, Chiappetta Porras LT. Management of gallstones and gallbladder disease in patients undergoing gastric bypass. World J Gastroenterol 2010; 16: 2075-9. 12. M. L. Shiffman, H. J. Sugerman, J. M. Kellum, W. H. Brewer, and E. W. Moore, “Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity,” The American Journal of Gastroenterology, vol. 86, no. 8, pp. 1000–1005, 1991. 13. Coşkun H, Hasbahçeci M, Bozkurt S, Çipe G, Malya FÜ, Memmi N et al. Is concomitant cholecystectomy with laparoscopic sleeve gastrectomy safe? Turk J Gastroenterol. 2014 Dec;25(6):624-7. 14. Erlinger S. Gallstones in obesity and weight loss. Eur J Gastroenterol Hepatol. 2000 Dec;12(12):1347-52. 15. Iglézias Brandão de Oliveira C, Adami Chaim E, da Silva BB. Impact of rapid weight reduction on risk of cholelithiasis after bariatric surgery. Obes Surg. 2003 Aug;13(4):625-8. 16. Manatsathit W, Leelasinjaroen P, Al-Hamid H, Szpunar S, Hawasli A. The incidence of cholelithiasis after sleeve gastrectomy and its association with weight loss: A two-centre retrospective cohort study. Int J Surg. 2016 Jun;30:13-8. 17. Li VK, Pulido N, Martinez-Suartez P, Fajnwaks P, Jin HY, Szomstein S, Rosenthal RJ. Symptomatic gallstones after sleeve gastrectomy. Surg Endosc. 2009 Nov;23(11):2488-92. 18. Hasan MY, Lomanto D, Loh LL, So JBY, Shabbir A. Gallstone Disease After Laparoscopic Sleeve Gastrectomy in an Asian Population-What Proportion of Gallstones Actually Becomes Symptomatic? Obes Surg. 2017 Sep;27(9):2419-2423. 19. Abdallah E, Emile SH, Elfeki H, Fikry M, Abdelshafy M, Elshobaky A et al. Role of ursodeoxycholic acid in the prevention of gallstone formation after laparoscopic sleeve gastrectomy. Surg Today. 2017 Jul;47(7):844-850.
Öz
Amaç: Dünya’da 18 yaş ve üzeri yetişkinlerin %13’ü obez olup, obeziteye komorbid hastalıklar da artmaktadır. Obezite cerrahisi sonrası
normal kiloya ulaşan hastalarda komorbid hastalıklarda iyileşme gözlenmektedir. Obezite ile safra kesesinde taş oluşumu insidansı
artmaktadır. Obezite cerrahisi sonrasında yeni taş gelişimi de yüksek oranlarda bildirilmektedir. Bu çalışmada Laparoskopik Sleeve
Gastrektomi (LSG) ameliyatı sonrası gelişebilecek safra kesesi taşı ve/veya komplikasyonlarının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Ankara Atatürk Eğitim ve Araştırma Hastanesinde Ocak 2013 ile Aralık 2016 yılları arasında LSG ameliyatı
yapılan 68 hastanın dosyası retrospektif olarak incelendi.
Bulgular: LSG ameliyatı olan kadın hastaların ortalama yaşı 42,95±10,72 yıl, erkek hastaların ortalama yaşı 36,23±10,76 yıldır. Ameliyat
öncesi kadın hastalarda vücut kütle indeksi (VKİ) ortalaması 45,26±3,58 kg/m2, erkeklerde 47,58±7,74 kg/m2 iken ameliyattan iki yıl
sonrasında VKİ ortalaması kadınlarda 27,18±2,80 kg/m2, erkeklerde 27,92±3,79 kg/m2 ye düştüğü saptandı (p<0,001). LSG operasyonu
geçiren hastaların 17(%31)’sinde safra kesesi taşı veya çamuru saptandı. Postoperatif safra kesesi taşı gelişen hastalardan birisinde
(%5,88) akut kolesistit geliştiği bulundu. LSG ameliyatı sonrası hastalar kilo kaybı açısından karşılaştırıldıklarında safra taşı gelişen ve
gelişmeyenler arasında istatistiksel olarak anlamlı bir farklılık saptanmadı (p=0,065).
Sonuç: LSG ameliyatı yapılacak hastalardan semptomatik kolelitiazis şikayeti olmayan hastalara laparoskopik kolesistektomi (LK)
yapılması gerekmedi. LSG ameliyatı sonrası safra kesesinde yeni taş gelişmesi yüksek oranda bulundu. Bununla birlikte bu taşlar erken
dönemde semptom vermediği için LSG hastalarının düzenli kontrolünün yapılmasının semptomatik kolelitiazis insidansını azaltacağı
kanaatindeyiz.
Anahtar Kelimeler
Morbid Obezite Laporoskopik Sleeve Gastrektomi Safra Kesesi Taşları Kolesistektomi
Kaynakça
- 1. World Health Organization. Obesity and overweight [Internet]. 2018 Feb 16; [cited 2018 August 30]. Available from: http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. 2. Republic of Turkey Ministry of Health. The Ministry of Health of Turkey, health statistics year book 2016. Ankara: SB-SAGEM-2017; [cited 2018 August 30]. Available from: http://ohsad.org/wp-content/uploads/2017/12/13160.pdf. 3. Kiriakopoulos A, Varounis C, Tsakayannis D, Linos D. Laparoscopic sleeve gastrectomy in morbidly obese patients. Technique and short term results. Hormones (Athens). 2009 Apr-Jun;8(2):138-43. 4. Eisenberg D, Bellatorre A, Bellatorre N. Sleeve gastrectomy as a stand-alone bariatric operation for severe, morbid, and super obesity. JSLS. 2013 Jan-Mar;17(1):63-7. 5. Al Zabadi H, Daqour A, Hawari A, Hasouni J. Short-term outcomes of laparoscopic sleeve gastrectomy among obesity patients in the Northern West Bank: a retrospective records review. BMC Res Notes. 2014 Feb 7;7:85. 6. Young MT, Gebhart A, Phelan MJ, Nguyen NT. Use and Outcomes of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Gastric Bypass: Analysis of the American College of Surgeons NSQIP. J Am Coll Surg. 2015 May;220(5):880-5. 7. Våge V, Sande VA, Mellgren G, Laukeland C, Behme J, Andersen JR. Changes in obesity-related diseases and biochemical variables after laparoscopic sleeve gastrectomy: a two-year follow-up study. BMC Surg. 2014 Feb 11;14:8. 8. Dittrick GW, Thompson JS, Campos D, Bremers D, Sudan D. Gallbladder pathology in morbid obesity. Obesity Surgery. 2005;15(2):238–242. 9. Eleni S, Dimitris Z, Eleni Z, Dimitris P, Ourania P, Georgia K, George T. Complicated Gallstones after Laparoscopic Sleeve Gastrectomy. Hindawi Publishing Corporation Journal of Obesity Volume 2014, Article ID 468203, 5. 10. Li VK, Pulido N, Fajnwaks P, et al. Erratum to “Predictors of gallstone formation after bariatric surgery: a multivariate analysis of risk factors comparing gastric bypass, gastric banding, and sleeve gastrectomy” Surgical Endoscopy. 2009;23(7):p. 1645. 11. Quesada BM, Kohan G, Roff HE, Canullan CM, Chiappetta Porras LT. Management of gallstones and gallbladder disease in patients undergoing gastric bypass. World J Gastroenterol 2010; 16: 2075-9. 12. M. L. Shiffman, H. J. Sugerman, J. M. Kellum, W. H. Brewer, and E. W. Moore, “Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity,” The American Journal of Gastroenterology, vol. 86, no. 8, pp. 1000–1005, 1991. 13. Coşkun H, Hasbahçeci M, Bozkurt S, Çipe G, Malya FÜ, Memmi N et al. Is concomitant cholecystectomy with laparoscopic sleeve gastrectomy safe? Turk J Gastroenterol. 2014 Dec;25(6):624-7. 14. Erlinger S. Gallstones in obesity and weight loss. Eur J Gastroenterol Hepatol. 2000 Dec;12(12):1347-52. 15. Iglézias Brandão de Oliveira C, Adami Chaim E, da Silva BB. Impact of rapid weight reduction on risk of cholelithiasis after bariatric surgery. Obes Surg. 2003 Aug;13(4):625-8. 16. Manatsathit W, Leelasinjaroen P, Al-Hamid H, Szpunar S, Hawasli A. The incidence of cholelithiasis after sleeve gastrectomy and its association with weight loss: A two-centre retrospective cohort study. Int J Surg. 2016 Jun;30:13-8. 17. Li VK, Pulido N, Martinez-Suartez P, Fajnwaks P, Jin HY, Szomstein S, Rosenthal RJ. Symptomatic gallstones after sleeve gastrectomy. Surg Endosc. 2009 Nov;23(11):2488-92. 18. Hasan MY, Lomanto D, Loh LL, So JBY, Shabbir A. Gallstone Disease After Laparoscopic Sleeve Gastrectomy in an Asian Population-What Proportion of Gallstones Actually Becomes Symptomatic? Obes Surg. 2017 Sep;27(9):2419-2423. 19. Abdallah E, Emile SH, Elfeki H, Fikry M, Abdelshafy M, Elshobaky A et al. Role of ursodeoxycholic acid in the prevention of gallstone formation after laparoscopic sleeve gastrectomy. Surg Today. 2017 Jul;47(7):844-850.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Aralık 2020 |
| Kabul Tarihi | 27 Kasım 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 4 Sayı: 3 |
Kaynak Göster
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https://doi.org/10.31201/ijhmt.1422564
Zonguldak Bülent Ecevit Üniversitesi Obezite ve Diyabet Uygulama ve Araştırma Merkezi’nin bilimsel yayım organıdır.
Web: https://obdm.beun.edu.tr/ Twitter: https://twitter.com/obezite_diyabet Instagram: https://www.instagram.com/zbeuobezitediyabet/