Incidence of Gallstone Formation and Cholecystectomy 10 Years After Bariatric Surgery.

PURPOSE: Rapid weight loss is a risk factor for gallstone formation, and postoperative treatment options for gallstone formation are still part of scientific discussion. No prospective studies monitored the incidence for gallstone formation and subsequent cholecystectomy after bariatric surgery longer than 5 years. The aim of the study was to determine the incidence of gallstone formation and cholecystectomy in bariatric patients over 10 years. MATERIALS AND METHODS: One hundred nine patients were observed over 10 years after laparoscopic gastric banding or gastric bypass/gastric sleeve. The incidence of gallstone formation and cholecystectomy was correlated to longitudinal changes in anthropometric parameters. RESULTS: In total, 91 female and 18 male patients were examined. Nineteen patients had postoperative gallstone formation, and 12 female patients required cholecystectomy. The number needed to harm for gallstone formation was 7.1 and 2.3 cases in the banding group and gastric bypass/gastric sleeve group, respectively. The number needed to harm for cholecystectomy was 11.6 and 2.5 cases in the banding group and the gastric bypass/gastric sleeve group, respectively. Weight loss was higher in patients requiring subsequent cholecystectomy. Mean follow-up to cholecystectomy was 21.5 months with the latest operation after 51 months. CONCLUSION: Female gender and rapid weight loss were major risk factors for postoperative cholelithiasis. Ultrasound examinations within 2 to 5 years are recommended in every patient, independent of bariatric procedure. Pharmacologic treatment should be considered in high risk patients within 2 to 5 years to prevent postoperative cholelithiasis. This helps to optimize patient care and lowers postoperative morbidity.

Single-incision laparoscopic cholecystectomy: will it succeed as the future leading technique for gallbladder removal?

BACKGROUND: The quest for less traumatic abdominal approaches is changing paradigms in times of minimally invasive surgery. While natural orifice translumenal endoscopic surgery remains experimental, the single-incision approach could be the future of gallbladder surgery. METHODS: Prospectively collected data from 875 patients subjected to conventional single-incision laparoscopic cholecystectomy (SILC) or 4-port [laparoscopic cholecystectomy (LC)] were retrospectively analyzed and discussed with the current literature. RESULTS: Between 2008 and 2011, 201 (23%) SILCs and 674 (77%) LCs were performed. Mean age was 51.7±17.5 years (SILC: 45.1 vs. LC: 53.7 y). Patients were predominantly female (SILC: 75.1% vs. LC: 56.5%). Preoperative body mass index was 27.4±9.1 (SILC: 26.4 vs. LC: 27.8; P<0.05) and American Society of Anesthesiologists' score counted 1.67±0.57 in SILC and 1.86±0.7 in LC patients. Acute inflammation of the gallbladder (AIG) was not considered as a contraindication for SILC (AIG in SILC: 17.4% vs. LC: 35.5%). The mean operative time was significantly lower in the SILC group (SILC: 71±31 vs. LC: 79±27 min) and duration of postoperative hospital stay was shorter (SILC: 3.2±1.7 vs. LC: 4.5±2.6 d). No significant difference was observed between SILC and LC in any of the registered complications, including postoperative bleeding, trocar hernias, wound infection, abdominal abscess formation, bile duct injury, or cystic duct leakage. CONCLUSIONS: In the near future SILC could overrule conventional LC as the leading technique for gallbladder surgery. Our data reconfirm an excellent risk profile for SILC that is equal to that of LC. Large multicenter randomized controlled trials will be required to finally legitimize SILC as the succeeding principal method.

Effect of weight loss on serum pigment epithelium-derived factor levels.

BACKGROUND: Cumulating evidence suggests that the broadly acting neurotrophic pigment epithelium-derived factor is associated with visceral adiposity, the metabolic syndrome, diabetes and exerts beneficial effects on atherosclerosis. To further elucidate the relationship between pigment epithelium-derived factor and metabolic perturbations characteristic of obesity, we examined the effect of pronounced weight loss on serum levels of pigment epithelium-derived factor. MATERIALS AND METHODS: Thirty-six severely obese adults were examined before and 18 months after bariatric surgery. Abdominal fat distribution was determined by ultrasound, metabolic parameters by standard methods, pro-inflammatory biomarkers and serum pigment epithelium-derived factor levels by enzyme-linked immunosorbent assay. RESULTS: Bariatric surgery resulted in a mean body mass index (BMI) reduction of 9·0 ± 5·0 kg m(-2) and concomitant improvements in glucose homoeostasis and lipid profile. Pigment epithelium-derived factor serum levels decreased from a median 11·0 µg mL(-1) (interquartile range: 3·8) to 9·2 µg mL(-1) (interquartile range: 4·5) (P < 0·0001). In univariate analysis, relative change in pigment epithelium-derived factor levels was significantly associated with change in weight, BMI, fat mass, visceral fat diameter, insulin, homoeostasis model for insulin resistance, triglyceride and leptin levels (all r > 0·370, P < 0·05). No associations were observed for C-reactive protein, interleukin-6 or tumour necrosis factor alpha. After adjustment for age, sex and smoking status, associations remained significant. CONCLUSIONS: The beneficial effects of bariatric surgery-induced pronounced weight loss on glucose homoeostasis may partially be attributable to visceral adipose tissue reduction and concomitantly decreasing pigment epithelium-derived factor concentrations.

Retinol-binding protein 4, visceral fat, and the metabolic syndrome: effects of weight loss.

Retinol-binding protein 4 (RBP-4) has been reported to be associated with visceral-fat accumulation and parameters of the metabolic syndrome (MetS). In this study, we investigated the relationship between RBP-4, visceral fat, and the MetS during pronounced weight loss after bariatric surgery. Thirty-six subjects were examined before and 2 years after surgery. Abdominal-fat distribution was determined by ultrasound, metabolic parameters, and serum RBP-4 levels by standard methods. After surgery BMI decreased by 9.07 kg/m(2), visceral-fat diameter (VFD) decreased by 60.6%, and RBP-4 serum levels by 16.6%. Change of RBP-4 levels was associated with reductions of waist (r = 0.364, P = 0.037), waist-to-hip ratio (WHR) (r = 0.415, P = 0.016), and VFD (r = 0.425, P = 0.010). MetS, as defined by International Diabetes Federation (IDF), was present in 19 patients at baseline and in nine patients at follow-up. Change in RBP-4 levels was the best predictor for the diagnosis of MetS at follow-up. In the subgroup without MetS at baseline, the decrease in RBP-4 levels (-28.1% vs. -6.3%, P = 0.020) and reduction in VFD (-66.9% vs. -55.0%, P = 0.038) were significantly greater compared to the subgroup with MetS. We demonstrate a marked decrease of RBP-4 levels after bariatric surgery, which correlates with reduction in visceral-fat mass. Furthermore, the extent of changes in RBP-4 levels differs according to the severity of the MetS.

A-FABP--a biomarker associated with the metabolic syndrome and/or an indicator of weight change?

OBJECTIVE: Adipocyte fatty acid-binding protein (A-FABP) is a plasma biomarker recently associated with the metabolic syndrome. The aim of these studies was to investigate changes of A-FABP during profound weight loss induced by laparoscopic adjustable gastric banding (LAGB). METHODS AND PROCEDURES: In study one, 29 severely obese female subjects were examined before and 1 year after surgical treatment. A subgroup of 10 patients was investigated in 3-month intervals. Metabolic parameters were determined using standard methods, and A-FABP was detected using a commercially available enzyme-linked immunosorbent assay. RESULTS: Mean weight loss after 1 year was 24.9 kg (P < 0.001), mainly due to a decrease in fat mass. Metabolic parameters improved substantially. However, serum A-FABP remained stable. In study two, a subgroup of 10 patients was examined quarterly to determine the time course of A-FABP changes. Quarterly measurements of serum A-FABP were significantly higher than baseline levels with the highest A-FABP value after the first 3 months, where patients had highest weight loss. DISCUSSION: Our results in study one show that A-FABP serum levels are positively associated with body weight and fat mass. However, 1 year after pronounced weight loss A-FABP levels remained unchanged. In study two, time course analyses revealed maximum increase of serum A-FABP in parallel to highest weight loss, which allows to suppose that A-FABP is not only a biomarker of the metabolic syndrome in the steady state, but also a marker of weight changes in dynamic situations.