Skip to main content
SpringerLink
Log in

Intraoperative ultrasound and prophylactic ursodiol for gallstone prevention following laparoscopic gastric bypass

  • Original article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background: Previous studies have shown that ursodiol decreases gallstone formation from 32% to 2% following open gastric bypass, but no data exist on laparoscopic Roux-en-Y gastric bypass (LRYGB) using intraoperative ultrasound (IOUS) screening. Methods: LRYGB with IOUS were performed on 195 consecutive patients. Patients with gallstones underwent simultaneous cholecystectomy, and patients without gallstones were prescribed ursodiol, 300 mg twice daily, for 6 month. Follow-up survey and ultrasound. Results: Of 195 patients, 44 (23%) had had a prior cholecystectomy, 21 (11%) underwent a simultaneous cholecystectomy, 129 (66%) had gallbladders left intact, and one (0.5%) false negative IOUS was excluded. Of 69 patients with ultrasound and survey follow-up (mean, 10 months), 19 (28%) developed gallstones seven with symptoms), and 50 (72%) were gallstone free. Forty-one percent of patients were compliant with ursodiol. There was no difference in compliance between patients with and without gallstones. In patients with gallstones, all of the symptomatic patients were noncompliant, whereas none of the compliant patients developed symptoms. Medication side-effects occurred in 17 of 69 patients (25%). Conclusions: IOUS during LRYGB efficiently screens for gallstones, and selective cholecystectomy followed by prophylactic ursodiol results in low morbidity. Improvements in compliance may lower the incidence of postoperative gallstone formation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. JF Amaral WR Thompson (1985) ArticleTitleGallbladder disease in the morbidly obese. Am J Surg 149 551–557 Occurrence Handle1:STN:280:BiqC2s3ksVE%3D Occurrence Handle3985293

    CAS  PubMed  Google Scholar 

  2. RE Brolin HA Kenler JH Gorman RP Cody (1992) ArticleTitleLong-limb gastric bypass in the superobese: a prospective randomized study. Ann Surg 215 387–395 Occurrence Handle1:STN:280:By2B3MvpvFA%3D

    CAS  Google Scholar 

  3. PH Broomfield R Chopra RC Sheinbaum GG Bonorris A Silverman LJ Schoenfield JW Marks (1988) ArticleTitleEffects of ursodeoxycholic acid and aspirin on the formation of lithogenic bile and gallstones during loss of weight. N Engl J Med 319 1567–1572 Occurrence Handle1:STN:280:BiaD2s%2FmtFc%3D Occurrence Handle3200265

    CAS  PubMed  Google Scholar 

  4. PS Choban J Onyejekwe JC Burge L Flancbaum (1999) ArticleTitleA health status assessment of the impact of weight loss following Roux-en-Y gastric bypass for clinically severe obesity. J Am Coll Surg 188 491–497 Occurrence Handle10.1016/S1072-7515(99)00030-7 Occurrence Handle1:STN:280:DyaK1M3kvFKmtw%3D%3D Occurrence Handle10235576

    Article  CAS  PubMed  Google Scholar 

  5. M Deitel I Petrov (1987) ArticleTitleIncidence of symptomatic gallstones after bariatric operations. Surg Gynecol Obstet 164 549–552

    Google Scholar 

  6. RA de la Torre JS Scott (1999) ArticleTitleLaparoscopic Roux-en-Y gastric bypass: a totally intra-abdominal approach — technique and preliminary report. Obes Surg 9 492–498 Occurrence Handle10.1381/096089299765552800 Occurrence Handle1:STN:280:DC%2BD3c%2FntF2htw%3D%3D Occurrence Handle10605909

    Article  CAS  PubMed  Google Scholar 

  7. RL Gebhard WF Prigge HJ Ansel L Schlasner SR Ketover D Sande K Holtmeier FJ Peterson (1996) ArticleTitleThe role of gallbladder emptying in gallstone formation during diet-induced rapid weight loss. Hepatology 24 544–548 Occurrence Handle1:CAS:528:DyaK28XlvVCrs7k%3D Occurrence Handle8781321

    CAS  PubMed  Google Scholar 

  8. KD Higa KB Boone T Ho (2000) ArticleTitleComplications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients — what have we learned? Obes Surg 10 509–513 Occurrence Handle10.1381/096089200321593706 Occurrence Handle1:STN:280:DC%2BD3M7ks1WjtQ%3D%3D Occurrence Handle11175957

    Article  CAS  PubMed  Google Scholar 

  9. JM Kellum EJ DeMaria HJ Sugerman (1998) ArticleTitleThe surgical treatment of morbid obesity. Curr Probl Surg 35 791–858 Occurrence Handle1:STN:280:DyaK1cvhvVWnsw%3D%3D Occurrence Handle9745619

    CAS  PubMed  Google Scholar 

  10. R Kolecki B Schirmer (1998) ArticleTitleIntraoperative and laparoscopic ultrasound. Surg Clin North Am 78 251–271

    Google Scholar 

  11. SP Lee K Maher JF Nichols (1988) ArticleTitleOrigin and fate of biliary sludge. Gastroenterology 94 170–176 Occurrence Handle1:STN:280:BieD1cvitlY%3D Occurrence Handle3275565

    CAS  PubMed  Google Scholar 

  12. InstitutionalAuthorNameNational Institutes of Health, National Heart, Lung, and Blood Institute (1998) ArticleTitleClinical guidelines on identification, evaluation, and treatment of overweight and obesity in adults — the evidence report. Obes Res 6 IssueIDSuppl 2 67S–82S

    Google Scholar 

  13. NT Nguyen C Goldman CJ Rosenquist A Arango CJ Cole SL Lee BM Wolfe (2001) ArticleTitleLaparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 234 279–291 Occurrence Handle10.1097/00000658-200109000-00002 Occurrence Handle1:STN:280:DC%2BD3MvotVymtA%3D%3D Occurrence Handle11524581

    Article  CAS  PubMed  Google Scholar 

  14. NT Nguyen SL Lee C Goldman N Fleming A Arango R Mcfall BM Wolfe (2001) ArticleTitleComparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: a randomized trial. J Am Coll Surg 192 469–477 Occurrence Handle10.1016/S1072-7515(01)00822-5 Occurrence Handle1:STN:280:DC%2BD3M3ivFSktg%3D%3D Occurrence Handle11294404

    Article  CAS  PubMed  Google Scholar 

  15. WJ Pories MS Swanson KG MacDonald et al. (1995) ArticleTitleWho would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222 339–350 Occurrence Handle1:STN:280:ByqH3cjps1I%3D Occurrence Handle7677463

    CAS  PubMed  Google Scholar 

  16. FJ Rybicki (2000) ArticleTitleThe WES sign. Radiology 214 881–882 Occurrence Handle1:STN:280:DC%2BD3c7osV2msw%3D%3D Occurrence Handle10715062

    CAS  PubMed  Google Scholar 

  17. PR Schauer S Ikramuddin WF Gourash R Ramanathan J Luketich (2000) ArticleTitleOutcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232 515–529 Occurrence Handle10.1097/00000658-200010000-00007 Occurrence Handle1:STN:280:DC%2BD3M%2Fhs1eitA%3D%3D Occurrence Handle10998650

    Article  CAS  PubMed  Google Scholar 

  18. JH Schmidt MP Hocking WR Rout ER Woodward (1988) ArticleTitleThe case for prophylactic cholecystectomy concomitant with gastric restriction for morbid obesity. Am Surg 54 269–272 Occurrence Handle1:STN:280:BieB3cfhtFM%3D Occurrence Handle3364862

    CAS  PubMed  Google Scholar 

  19. DJ Scott DB Jones (1999) Hernia. RN McClelland (Eds) Selected readings general surgery, 1–55

    Google Scholar 

  20. DJ Scott DA Provost DB Jones (2000) ArticleTitleLaparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Rounds 23 177–189

    Google Scholar 

  21. DJ Scott DA Provost DB Jones (2000) ArticleTitleLaparoscopic Roux-en-Y gastric bypass: transoral or transgastric anvil placement? Obes Surg 10 361–365 Occurrence Handle10.1381/096089200321629139 Occurrence Handle1:STN:280:DC%2BD3cvlt12lug%3D%3D Occurrence Handle11007630

    Article  CAS  PubMed  Google Scholar 

  22. DJ Scott DA Provost TT Tesfay DB Jones (2001) ArticleTitleLaparoscopic Roux-en-Y gastric bypass using the porcine model. Obes Surg 11 46–53 Occurrence Handle10.1381/096089201321454105 Occurrence Handle1:STN:280:DC%2BD3M3mvFGjsA%3D%3D Occurrence Handle11361168

    Article  CAS  PubMed  Google Scholar 

  23. ML Shiffman GD Kaplan V Brinkman-Kaplan FF Vickers (1995) ArticleTitleProphylaxis against gallstone formation with ursodeoxycholic acid in patients participating in a very-low-calorie diet program. Ann Int Med 122 899–905 Occurrence Handle1:STN:280:ByqB2svos1M%3D

    CAS  Google Scholar 

  24. ML Shiffman HJ Sugerman JM Kellum WH Brewer EW Moore (1991) ArticleTitleGallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol 86 1000–1005 Occurrence Handle1:STN:280:By6A3MvltlY%3D Occurrence Handle1858735

    CAS  PubMed  Google Scholar 

  25. ML Shiffman HJ Sugerman JM Kellum WH Brewer EW Moore (1993) ArticleTitleGallstones in patients with morbid obesity: relationship to body weight, weight loss and gallbladder bile cholesterol solubility. Int J Obes 17 153–158 Occurrence Handle8385075

    PubMed  Google Scholar 

  26. O Shoheiber JE Biskupiak DB Nash (1997) ArticleTitleEstimation of the cost savings resulting from the use of ursodiol for the prevention of gallstones in obese patients undergoing rapid weight reduction. Int J Obes 21 1038–1045 Occurrence Handle10.1038/sj.ijo.0800513 Occurrence Handle1:CAS:528:DyaK2sXnsV2itrw%3D

    Article  CAS  Google Scholar 

  27. CD Sjostrom L Lissner H Wedel L Sjostrom (1999) ArticleTitleReduction in incidence of diabetes, hypertension, and lipid disturbances after intentional weight loss induced by bariatric surgery: the SOS intervention study. Obes Res 7 477–484 Occurrence Handle1:STN:280:DyaK1Mvjslejtg%3D%3D Occurrence Handle10509605

    CAS  PubMed  Google Scholar 

  28. HJ Sugerman WH Brewer ML Shiffman RE Brolin MAL Fobi JH Linner KG MacDonald AM MacGregor LFO-SJC Martin D Popoola et al. (1995) ArticleTitleA multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric- bypass–induced rapid weight loss. Am J Surg 169 91–97 Occurrence Handle10.1016/S0002-9610(99)80115-9 Occurrence Handle1:STN:280:ByqC3Mjns1w%3D Occurrence Handle7818005

    Article  CAS  PubMed  Google Scholar 

  29. HJ Sugerman JM Kellum D Reines et al. (1996) ArticleTitleGreater risk of incisional hernia with morbidly obese than steroid-dependent patients and low recurrence with prefascial polypropylene mesh. Am J Surg 171 80–84 Occurrence Handle8554156

    PubMed  Google Scholar 

  30. DA Wattchow JC Hall MJ Whiting B Bradley J Iannos JM Watts (1983) ArticleTitlePrevalence and treatment of gallstones after gastric bypass surgery for morbid obesity. Br Med J 286 763 Occurrence Handle1:STN:280:BiyC38fkslU%3D

    CAS  Google Scholar 

  31. AC Wittgrove GW Clark KR Schubert (2000) ArticleTitleLaparoscopic gastric bypass, Roux-en-Y: the results in 500 patients with 5-year follow-up. Obes Surg 10 233–239 Occurrence Handle1:STN:280:DC%2BD3cvotFOlsQ%3D%3D Occurrence Handle10929154

    CAS  PubMed  Google Scholar 

  32. AC Wittgrove GW Clark LJ Tremblay (1994) ArticleTitleLaparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases. Obes Surg 4 353–357 Occurrence Handle10.1381/096089294765558331 Occurrence Handle10742801

    Article  PubMed  Google Scholar 

  33. LJ Worobetz FG Inglis EA Shaffer (1993) ArticleTitleThe effect of ursodeoxycholic acid therapy on gallstone formation in the morbidly obese during rapid weight loss. Am J Gastroenterol 88 1705–1710 Occurrence Handle1:STN:280:ByuD38npsVQ%3D Occurrence Handle8213711

    CAS  PubMed  Google Scholar 

  34. LJ Wudel JK Wright JP Debelak TM Allos Y Shyr WC Chapman (2001) ArticleTitlePrevention of gallstone formation in morbidly obese patients undergoing rapid weight loss: results of a randomized controlled pilot study. J Surg Res 102 50–56 Occurrence Handle10.1006/jsre.2001.6322

    Article  Google Scholar 

  35. F Yost J Margenthaler M Presti F Burton K Murayama (1999) ArticleTitleCholecystectomy is an effective treatment for biliary dyskinesia. Am J Surg 178 462–465 Occurrence Handle1:STN:280:DC%2BD3c7jsVeisQ%3D%3D Occurrence Handle10670853

    CAS  PubMed  Google Scholar 

  36. RK Zeman BS Garra (1991) ArticleTitleGallbladder imaging: state of the art. Gastroenterol Clin North Am 20 127–156 Occurrence Handle1:STN:280:By6B3MnmsVM%3D Occurrence Handle2022418

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Funding was provided by the Southwestern Center for Minimally Invasive Surgery, as supported in part by an educational grant from the US Surgical Corporation — a division of the Tyco Healthcare Group. Equipment was provided by B & K Medical.

Author information

Authors and Affiliations

  1. Southwestern Center for Surgery for Obesity, Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75235-9092, USA

    D. J. Scott, L. Villegas, T. L. Sims, E. C. Hamilton, D. A. Provost & D. B. Jones

Authors
  1. D. J. Scott
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Villegas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. L. Sims
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. C. Hamilton
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. A. Provost
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. B. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D. B. Jones.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Scott, D., Villegas, L., Sims, T. et al. Intraoperative ultrasound and prophylactic ursodiol for gallstone prevention following laparoscopic gastric bypass . Surg Endosc 17, 1796–1802 (2003). https://doi.org/10.1007/s00464-002-8930-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-002-8930-7

Keywords

Search

Navigation