Gallbladder Pathology in Morbid Obesity

Background: Obese patients are at increased risk for biliary disease. The prevalence and type of gallbladder pathology in morbidly obese patients was evaluated, and compared with a non-obese control group. Methods: A consecutive series of obese patients (n=478) who had undergone bariatric surgery with concurrent routine cholecystectomy and a consecutive group of organ donors (n=481) were compared. Gallbladder pathology was defined as: cholelithiasis, cholecystitis, cholesterolosis, or normal pathology. Results: Mean age of obese patients and of donors was 42 ± 9 and 43 ± 17 years respectively and mean BMI was 52 ± 10 and 27 ± 7 kg/m² respectively, P<0.05. There were more females in the obesity group (88% vs 47%, P<0.0001). 31% of obese patients and 7% of controls had a previous cholecystectomy (P<0.0001). 21% of the obese and 72% of the controls had normal gallbladder pathology (P<0.0001). Overall, obese patients had a higher incidence of cholelithiasis (25% vs 5%, P<0.0001), cholecystitis (50% vs 17%, P<0.0001), and cholesterolosis (38% vs 6%, P<0.0001) compared with controls. Obese patients with BMI <50 were more likely than those with BMI ≥50 to have normal gallbladder pathology (27% vs 14%, P<0.001). Female patients were more likely to have undergone previous cholecystectomy than males in both the obese group (34% vs 11%, P<0.001) and the control group (12% vs 2%, P<0.0001). Normal pathology was more common in male patients (80% vs 63%, P<0.0001) and patients <50 years (76% vs 66%, P<0.05) in the control group. Conclusions: Obese patients have an increased incidence of benign gallbladder disease than a group of controls, and the relative risk appears to be positively correlated with the level of increase in the BMI. Obesity appears to change the effect of age and gender on gallbladder pathology.     

Prophylactic Cholecystectomy with Open Gastric Bypass Operation

Background: There has been controversy regarding prophylactic cholecystectomy with Roux-en Y gastric bypass. The results reported in open cases showed no significant increase in morbidity by the addition of cholecystectomy. A series of open cases were reviewed to evaluate the propriety of prophylactic cholecystectomy. Method: The records of 141 patients undergoing cholecystectomy during open gastric bypass were reviewed, documenting age, ultrasound findings and pathology. Results: Of the 141 cases analyzed, the incidence of gall-bladder pathology was 80%. 24 (17%) of the 141 patients were noted to have gallstones on preoperative ultrasound examination, and 3 (2%) showed polyps. 9 patients (6%) had gallstones at surgery with normal ultrasound. Cholesterolosis was present in 52 cases (37%) and chronic cholecystitis in 25 cases (18%). Conclusion: In view of the high incidence of gall-bladder disease (80%) already present in morbidity obese patients undergoing gastric bypass and the lack of significant morbidity in open surgery with prophylactic cholecystectomy, the addition of prophylactic cholecystectomy appears appropriate.     

急性胆囊炎经腹腔镜胆囊切除的临床评价

目的：探讨急性胆囊炎经腹腔镜胆囊切除（LC）的可行性及相关处理。方法：分析急性胆囊炎经LC手术106例患者的临床资料。结果：106例患者中除6例中转开腹手术，其余均手术成功，全组无手术并发症发生。结论：急性胆囊炎采用LC手术治疗是可行的。关键是手术者的经验及手术的技巧。     

A Study of Pain after Laparoscopic Gastric Banding

Background: The introduction of the laparoscopic approach to bariatric surgery has brought similar advantages as those seen in general surgery.There have been no trials assessing postoperative pain after laparoscopic adjustable silicone gastric banding (LASGB). We compared prospectively postoperative pain and outcome in LASGB and laparoscopic cholecystectomy (LC), to determine if morbidly obese patients can expect the same benefits from a laparoscopic approach in gastric banding as those which are known for LC in non-obese and obese patients. Methods: In a prospectively collected database of 80 patients undergoing LASGB, information including a survey assessing the postoperative pain, the amount of analgetic drugs used, operative reports, laboratory data, and follow-up data was collected. This was compared to an equal number of patients undergoing LC. Postoperatively,all patients received standardized pain medication of 150 mg tramadol per day. Pain was assessed twice on postoperative days 1-3 using a patient questionnaire. Results: Patient characteristics and duration of hospital stay were similar in the two groups. Although there was no significant difference in type and intensity of pain experienced by the patients in either group, the gastric banding patients reported less postoperative pain overall than those in the LC group. Conclusion: The analyzed data show that LASGB offers the same advantages as other laparoscopic operations, in that it induces less pain and enables the patient to return quickly to normal activity and work. The advantage over the compared LC group may be due to higher patient motivation, but was not statistically significant.     

Prophylactic cholecystectomy with gastric bypass operation: incidence of gallbladder disease

Background: Morbid obesity is one of the major risk factors for gallbladder disease, and this risk is even greater following rapid weight loss. Because of this, prophylactic cholecystectomy has been offered to our patients undergoing the transected silastic ring vertical Roux-en-Y gastric bypass (TSRVRYGBP). A study was undertaken to determine the incidence of pathologic gallbladders in patients undergoing this prophylactic cholecystectomy. Method: The records of all patients who underwent TSRVRYGBP from June 1999 through December 2000 were reviewed. Pathologic findings of the gallbladder were documented as cholelithiasis, cholecystitis, cholesterolosis, polyps or normal. Results: 761 patients underwent the operation. 178 patients (23%) had cholecystectomy before the surgery. 154 (20%) had gallstones documented by ultrasound and had cholecystectomy at the time of the surgery. 324 of the 429 patients with negative preoperative findings by ultrasound had pathologic evidence of gallbladder disease. Conclusion: Because of the high incidence of gallbladder disease even with negative preoperative findings in morbidly obese patients and the lack of significant morbidity with cholecystectomy in experienced hands, routine cholecystectomy at the time of the weight loss operation is justified.     

结石性残株胆囊炎的诊治体会:附36例报告

目的：探讨结石性残株胆囊炎的原因、诊断及手术治疗方法。方法：对36例经手术证实的结石性残株胆囊炎的临床资料进行回顾性分析。结果：36例均经再次手术治愈,其中残株胆囊切除8例,残株胆囊切除、胆总管切开探查或／和取石、T管引流28例。31例（86．1％）获随访,随访3个月－12年,效果优良率为93．5％。结论：引起结石性残株胆囊炎的主要原因行胆囊切除术时是未遵循辨“辨切辨”三字程序。其主要症状和体征与结石性胆囊炎相似。诊断上各项辅助检查的准确率不高,必须对各项检查进行综合分析。治疗上必须遵循“辨切辨”三字程序,先切开胆总管、肝总管,再切除残株胆囊。     

腹腔镜胆囊切除术与内镜括约肌切开取石术联合治疗胆囊胆总管结石

目的 探讨腹腔镜胆囊切除术(LC)与内镜Oddi括约肌切开取石术(EST)联合治疗胆囊胆总管结石的临床效果.方法 回顾分析LC与EST联合治疗胆囊胆总管结石20例的临床资料、结果手术成功率95．0％，结石取净率100．0％，无并发症，平均住院7．5d结论LC与EST联合治疗胆囊胆总管结石是一种安全有效的治疗方法。