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Gallstone Development after Obesity Surgery

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Obesity is a serious disease which has a high level of morbidity and mortality, and a complex genetic and environmental etiology. It causes diseases such as hypertension, hyperlipidemia, cardiomyopathy, diabetes, hypoventilation disorders, increased malignity risk, gallbladder, degenerative arthritis, infertility and psychological disorders.

 

Gallbladder disease is one of the most frequent problems that affect the digestive system and its frequency is declared to be between 11-36% in autopsy works. The likelihood of developing gallbladder is high in obesity, pregnancy, dietary factors, Crohn disease, terminal ileum resection, stomach surgery, hereditary spherocytosis, sickle cell anemia and thalassemia. Women are 3 times risky comparing to men and this risk is doubled in the 1st degree relatives of patients having gallbladder.

 

Considering the literature, the gallbladder frequency in morbid obese patients varies between 21-33% and about 50% of them had cholecystectomy (gallbladder surgery)before bariatric surgery. In heavy obese patients, the secretion of cholesterol by liver is increased. This results in an increase of the cholesterol concentration without having a proportional increase in phospholipid and bile salt. Also, obese patients have a gallbladder whose contractility is reduced. These different mechanisms are responsible for the increase of the frequency of gallstone in obese patients.

 

The frequency of gallstone development due to the fast weight loss after bariatric surgery and especially Roux en-y gastric bypass has increased comparing to the normal population. Super-saturation of hepatic gallbladder with cholesterol, gallbladder stasis and the increased concentration of mucin inside the gallbladder are the possible causes.

 

The management of gallstone in these patients is still controversial and some therapeutic modalities are used. They are; simultaneous cholecystectomy of all patients during gastric bypass (prophylactic approach) regardless of that they are gallstones or not, simultaneous cholecystectomy of all patients having gallstones (elective or selective approach) and simultaneous cholecystectomy of patients having both gallstones and symptoms and afterwards, prophylactic ursodeoxycholic acid treatment until the symptoms develop (conventional approach).