Prevalence of gallstones in 1,229 patients submitted to surgical laparoscopic treatment of GERD and esophageal achalasia: associated cholecystectomy was a safe procedure

Background

Association between esophageal achalasia/ gastroesophageal reflux disease (GERD)and cholelithiasis is not clear. Epidemiological data are controversial due todifferent methodologies applied, the regional differences and the number ofpatients involved. Results of concomitant cholecistectomy associated to surgicaltreatment of both diseases regarding safety is poorly understood.

Aim

To analyze the prevalence of cholelithiasis in patients with esophageal achalasiaand gastroesophageal reflux submitted to cardiomyotomy or fundoplication. Also, toevaluate the safety of concomitant cholecistectomy.

Methods

Retrospective analysis of 1410 patients operated from 2000 to 2013. They weredivided into two groups: patients with GERD submitted to laparocopic hiatoplastyplus Nissen fundoplication and patients with esophageal achalasia to laparoscopiccardiomyotomy plus partial fundoplication. It was collected epidemiological data,specific diagnosis and subgroups, the presence or absence of gallstones, surgicalprocedure, operative and clinical complications and mortality. Allgroups/subgroups were compared.

Results

From 1,229 patients with GERD or esophageal achalasia, submitted to laparoscopiccardiomyotomy or fundoplication, 138 (11.43%) had cholelitiasis, occurring more infemales (2.38:1) with mean age of 50,27 years old. In 604 patients with GERD, 79(13,08%) had cholelitiasis. Lower prevalence occurred in Barrett''s esophaguspatients 7/105 (6.67%) (p=0.037). In 625 with esophageal achalasia, 59 (9.44%) hadcholelitiasis, with no difference between chagasic and idiopathic forms (p=0.677).Complications of patients with or without cholecystectomy were similar infundoplication and cardiomyotomy (p=0.78 and p=1.00).There was no mortality orcomplications related to cholecystectomy in this series.

Conclusions

Prevalence of cholelithiasis was higher in patients submitted to fundoplication(GERD). Patients with chagasic or idiopatic forms of achalasia had the sameprevalence of cholelithiasis. Gallstones occurred more in GERD patients withoutBarrett''s esophagus. Simultaneous laparoscopic cholecystectomy was provedsafe.