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Some risk factors of gallstone formation after laparoscopic sleeve gastrectomy and the role of ezetimibe versus ursodeoxycholic acid in its prevention

The Egyptian Journal of Internal Medicine volume 26, pages 75–79 (2014)Cite this article

Abstract

Aims

Obese patients are at increased risk for gallstones during rapid weight loss and after laparoscopic sleeve gastrectomy. The aims of this study were to evaluate the prophylactic effect of ursodeoxycholic acid and ezetimibe for prevention of gallstone formation after sleeve gastrectomy and to identify some risk factors.

Settings and design

This was a prospective randomized study conducted at Al Rashid Hospital, Kuwait.

Patients and methods

A total of 215 obese patients were included. Preoperative assessment was performed, including history, examination, obesity evaluation (body weight, BMI, waist circumference), full laboratory work, gastroscopy, and abdominal ultrasonography. After laparoscopic sleeve gastrectomy. patients were divided randomly into: group 1 (control), group 2 (ursodeoxycholic acid), and group 3 (ezetimibe). Patients were scheduled for 3-, 6-, and 12-month visits for assessment of % excess weight loss and abdominal ultrasonography.

Results

A significant reduction in gallstone formation was found in the ezetimibe group (5.5%) compared with the control group (17.6%). A statistically significant increase in % excess weight loss was observed in patients with gallstones (38.5%) versus patients without gallstones (28.2%). Percentage of gallstone formation during first 6 months postoperatively was double that during the next 6 months in both the control and treatment groups.

Conclusion

Risk of gallstone formation during the first 6 months after laparoscopic sleeve gastrectomy was double that during the second 6 months. Ezetimibe is effective in reducing relative risk by 70% and ursodeoxycholic acid by 50% versus control; hence, we recommend usage of one of these medications for 1 year postoperatively. Furthermore, we recommend more work on combining both medications together.

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Authors and Affiliations

  1. Head of Internal Medicine Department, Mansoura University, Po Box 8999, 22060, Mansoura, Salmyia, Kuwait

    Alaa Elgamal MD (Assistant Professor of Internal Medicine, Mansoura Faculty of Medicine)

  2. Professor of Surgery, Menofia Faculty of Medicine, Menofia University, Menofia, Egypt

    Ahmad Tarek Fawzy

Authors
  1. Alaa Elgamal MD
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  2. Ahmad Tarek Fawzy
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Correspondence to Alaa Elgamal MD.

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Elgamal, A., Fawzy, A.T. Some risk factors of gallstone formation after laparoscopic sleeve gastrectomy and the role of ezetimibe versus ursodeoxycholic acid in its prevention. Egypt J Intern Med 26, 75–79 (2014). https://doi.org/10.4103/1110-7782.139548

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  • DOI: https://doi.org/10.4103/1110-7782.139548

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