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    • The Added Value of Concomitant Laparoscopic Cholecystectomy and Sleeve Gastrectomy in Morbidly Obese Patients with Gall Stone Disease (A prospective Single Arm Study)

    Ahmed Maher AbdElmonim, RehamEltatawy, Ayman S. El-Din Helmy, Mohamed Hassan Ali Fahmy, Mohammed Elshal
    Department of Surgery, Kasr Alaiany, Faculty of Medicine, Cairo Universtiy

    Background: Nowadays obesity is one of the most important health problems. Morbid obesity is defined when the body mass index exceeds 40 kg/m². Obesity is an independent risk factor for gallstones. In obese patients, gallstone is more symptomatic than in non-obese people. Bariatric procedures have been accelerating with simultaneous cholecystectomy application nowadays. However, the routine application of prophylactic cholecystectomy in patients with obesity surgery with gallstone has been discussed in previous literatures. Prophylactic cholecystectomy has come onto the agenda due to adhesions that may occur after past surgery, but currently it is not routinely accepted. Cholecystectomy is recommended in symptomatic patients. Methods: A prospective single arm clinical trial including 48 obese patients presenting in bariatric clinic in Cairo university hospitals. Proper history was taken and investigations including abdominal ultrasound (US) were done to include the patients with gall stone disease whether symptomatic or not. The presence of preoperative gastroesophageal reflux disease (GERD) symptoms is assessed using Reflux symptomIndex (RSI)[1]. All patients underwent concomitant laparoscopic sleeve gastrectomy and cholecystectomy and the clinical outcome of the procedure was evaluated in terms of postoperative complications including leakage whether gastric or biliary, bleeding, jaundice, and surgical site infection (SSI), operative time and postoperative stay. A 1 month postoperative Reflux Symptom Index score is compared to that collected preoperatively.

    Results: In this study, 48 obese patients were included (males 31.3%, females 68.8%) with a mean age of 37.8 years (range 19-59). Regarding GERD assessment using RSI, we found statistically significant deterioration in RSI score collected 1 month postoperatively in comparison to preoperative score (P-value <0.001) with 22% of the cases developing de novo postoperative GERD. On the other hand, incidence of postoperative complications in general was 6.25% including leakage (gastric 2.08%, biliary 2.08%) , SSI (4.16%), bleeding and jaundice (0%) while the mean operative time was 112 minutes (range 160-85 mins) and the mean postoperative stay was 2 days (range 12-1 days). Conclusion: In this study, Concomitant laparoscopic sleeve gastrectomy and cholecystectomy caused significant postoperative increase in GERD symptoms as interpreted by the subjective RSI score while no significant increase in postoperative complications including leakage (whether biliary or gastric), bleeding, SSI or jaundice. Operative time and postoperative stay were not significantly prolonged.

    Keywords: Obesity, sleeve gastrectomy, cholecystectomy, GERD.

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