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Ursodeoxycholic acid for the prevention of gall stones after laparoscopic sleeve gastrectomy: a prospective controlled study

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Abstract

Background

Obesity is a risk factor for cholelithiasis. Besides, rapid weight loss after bariatric surgery upsurges the rate of cholelithiasis and acute cholecystitis. This study aimed to compare gallstone development frequency after LSG under ursodeoxycholic acid (UDCA) prophylaxis.

Methods

This prospective controlled study included 332 patients scheduled for LSG randomized to receive 500 mg UDCA daily for 12 months (UDCA Group) or no treatment (Control Group). Ultrasonography was done 6 and 12 months after surgery to detect gallstones. Cholecystectomy was done for complicated cases of cholelithiasis.

Results

Seventy-one patients were lost to follow-up, and 3 developed severe adverse effects of UDCA and excluded. Data are presented for 130 patients in the UDCA group and 128 in the Control group. Collectively, 11 patients (8.5%) of the UDCA group and 41 (32.0%) of the Control group developed gall stones during the first postoperative year (p < 0.001). Cholecystectomy was indicated in 3 patients (2.3%) of the UDCA group and 9 (7.0%) of the Control group (p = 0.072). On multivariate analysis, higher BMI, dyslipidemia, and lacking UDCA prophylaxis were the independent factors significantly associated with stone development. Also, stone development was associated with higher weight loss after 6 and 12 months.

Conclusion

UDCA 500 mg once daily for 12 months after LSG is effective in reducing gallstone formation at 1 year. UDCA administration reduced the frequency of cholecystectomies from 7 to 2.3%. High BMI and dyslipidemia are the independent preoperative factors significantly associated with stone development.

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Authors and Affiliations

  1. General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt

    Mohamed AbdAlla Salman, Usama Shaker Mohamed, Ahmed Mahmoud Hussein, Mahmoud A. Ameen, Haitham S. E. Omar & Hany Balamoun

  2. Internal Medicine Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt

    Ahmed Salman

  3. Department of General Surgery, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt

    Ahmed Elewa, Ahmed Hamdy & Tamer Omar

  4. Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit branch, Assuit, Egypt

    Abd Al-Kareem Elias

  5. Great Western Hospital, NHS Foundation Trust, London, UK

    Mohamed Tourky, Alaa Helal & Ahmed Abdelrahman Mahmoud

  6. Lewisham and Greenwich NHS Trust, London, UK

    Feras Aljarad

  7. Endemic Medicine and Hepatology Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt

    Ahmed Moustafa

  8. Gastroentrology and Hepatology, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt

    Hossam El-Din Shaaban

  9. Ahmed Maher Teaching Hospital (AMTH), Cairo, Egypt

    Ahmed Nashaat

  10. Faculty of Medicine, Al Azhar University, Cairo, Egypt

    Amr Mahmoud Hussein

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  1. Mohamed AbdAlla Salman
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Correspondence to Mohamed AbdAlla Salman.

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Disclosures

Drs. Mohamed AbdAlla Salman, Ahmed Salman, Usama Shaker Mohamedm Ahmed Mahmoud Hussein, Mahmoud A. Ameen, Hitham S.E. Omar, Ahmed Elewa, Ahmed hamdy, Abd Al-Kareem Elias, Mohamed Tourky, Alaa Helal, Ahmed Abdelrahman Mahmoud, Feras Aljarad, Ahmed Moustafa, Hossam El-Din Shaaban, Ahmed Nashat, Amr Mahmoud Hussein, Tamer Omar, and Hany Balamoun have no conflicts of interest or financial ties to disclose.

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Salman, M.A., Salman, A., Mohamed, U.S. et al. Ursodeoxycholic acid for the prevention of gall stones after laparoscopic sleeve gastrectomy: a prospective controlled study. Surg Endosc 36, 6396–6402 (2022). https://doi.org/10.1007/s00464-021-08980-3

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