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Predictive Factors of Cholelithiasis After Prophylactic Administration of Ursodeoxycholic Acid Following Laparoscopic Bariatric Surgery: Tehran Obesity Treatment Study

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Abstract

Purpose

Cholelithiasis is a well-known consequence of obesity as well as rapid weight loss especially after bariatric surgery. A routine postoperative course of ursodeoxycholic acid (UDCA) is recommended as a prophylactic measure against gallstone formation. However, the efficacy of UDCA after bariatric surgery and predictors of cholelithiasis despite prophylaxis are not well understood. We assessed the incidence and predictors of de novo cholelithiasis after bariatric surgery in patients who received UDCA prophylaxis.

Methods

Uniform data from 2629 consecutive patients who underwent either sleeve gastrectomy or gastric bypass between March 2013 and 2018 were collected prospectively. All patients received a 6-month course of UDCA 300 mg twice daily. Cholelithiasis was assessed with abdominal ultrasound at baseline as well as 6, 9, 12, 18, and 24 months postoperatively. The association between cholelithiasis and its predictors was examined by Cox proportional hazards models and restricted cubic spline regression.

Results

The cumulative rate of cholelithiasis in 24 months after surgery was 10.8% (n = 283) with the greatest incidence within the first year. After multivariate analysis, 6-month body mass index (BMI) loss was found to be the only independent predictor for postoperative cholelithiasis (HR = 1.10 [95% CI: 1.04–1.16]). The concordance index for predicting cholelithiasis was 0.60 (0.56–0.64) for 6-month BMI loss.

Conclusion

Early postoperative rapid weight loss as represented by 6-month BMI loss is the main predictor of de novo cholelithiasis after bariatric surgery, although this parameter does not have enough power for discrimination of postoperative cholelithiasis.

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Acknowledgements

The authors would like to thank the hospital staff, study assistants, and coordinators that took part in this research. Also, especial thanks to Mohammadreza Golsibi for his assistance and support of the electronic data collection system. This article was derived from the disease registry entitled “Registration of patient in Tehran Obesity Treatment Center” and approved under the ethical code of “IR.SBMU.ENDOCRINE.REC1397.059” (date: 2018-05-08) by the local ethic committee. The study was supported by the deputy of research and technology of Shahid Beheshti University of Medical Sciences (dregistrysbmu.ac.ir).

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Authors and Affiliations

  1. Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Maryam Barzin, Maryam Mahdavi, Majid Valizadeh, Pouria Mousapour & Farhad Hosseinpanah

  2. Department of Surgery, Center for Bariatric Surgery, McGill University, Montreal, QC, Canada

    Amin Andalib

  3. Department of Surgery, Faculty of Medicine, Tehran Obesity Treatment Center, Shahed University, Tehran, Iran

    Alireza Khalaj

Authors
  1. Maryam Barzin
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Correspondence to Pouria Mousapour or Farhad Hosseinpanah.

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Ethics Approval

This study was approved by the institutional review board (no. IR.SBMU. ENDOCRINE.REC 1397.0592018–05-08). Informed consent was obtained from all the participants included in the study. All procedures were performed in accordance with the ethical standards of the institutional and national research committees and 1964 Helsinki Declaration and its later amendments.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Key points

• Postoperative use of ursodeoxycholic acid (UDCA) is associated with reduced gallstone formation.

• Six-month BMI loss after bariatric surgery is the only predictor of de novo cholelithiasis in patients who received postoperative UDCA prophylaxis.

• This parameter did not have enough power for discrimination of cholelithiasis after bariatric surgery.

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Barzin, M., Andalib, A., Khalaj, A. et al. Predictive Factors of Cholelithiasis After Prophylactic Administration of Ursodeoxycholic Acid Following Laparoscopic Bariatric Surgery: Tehran Obesity Treatment Study. OBES SURG 32, 311–317 (2022). https://doi.org/10.1007/s11695-021-05777-0

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  • DOI: https://doi.org/10.1007/s11695-021-05777-0

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