Prevalence and Management of Gall Stones in Sleeve Gastrectomy

Introduction: Obesity is a public health problem with increased prevalence, recent exciting studies linked cholelithiasis to obesity and reduction of weight. Abdominal Ultrasound is essential preoperative work up to reveal cholelithiasis-related obesity. The objective of this study is to determine the incidence of cholelithiasis in morbidly obese patients, pre-and post Laparoscopic Sleeve Gastrectomy (LSG) and to evaluate the outcome of concomitant cholecystectomy when laparoscopic sleeve gastrectomy is combined with cholecystectomy in the same setting.

Materials and Methods: This retrospective study was applied on 221 cases of laparoscopic sleeve gastrectomies, performed for morbid obesity in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 2013 to December 2015.

Preoperative preparation including trans-abdominal ultrasound to rule out Cholelithiasis was fulfilled. Patients with symptomatic Cholelithiasis were informed about the possibility of performing combined (concomitant) cholecystectomy with the sleeve gastrectomy.

Results: 33 out of 221 (15%) of the morbidly obese patients, who were admitted for LSG had cholelithiasis, 28/221 (12.7%) were diagnosed preoperatively, while 5/221 (2.3%) developed it postoperatively.

The age of the cholelithiasis group ranges between 19-51 years, with a mean of 37.4 year old. 28 females, 5 males were involved in the study which represent 85%, 15% for females and males respectively.

Conclusion: This study illustrated the high incidence of gall stones before sleeve gastrectomy indicates abdominal ultrasound as an essential preoperative work up, while advised to be done selectively for the symptomatic cases during follow-up period based on the low incidence of postoperative cholelithiasis. Our study also highlighted the successful management of concomitant cholecystectomy when laparoscopic sleeve gastrectomy is combined with cholecystectomy in the same setting.