Ömer PARLAK, Abdurrezzak YILMAZ, Emin GEMCİOĞLU, Servet KOCAÖZ

Obezite Cerrahisi Sonrası Semptomatik Kolelitiazis Gelişme Sıklığı ve Cerrahi Tedavide Zamanlama

Amaç: Dünya’da 18 yaş ve üzeri yetişkinlerin %13’ü obez olup, obeziteye komorbid hastalıklar da artmaktadır. Obezite cerrahisi sonrası normal kiloya ulaşan hastalarda komorbid hastalıklarda iyileşme gözlenmektedir. Obezite ile safra kesesinde taş oluşumu insidansı artmaktadır. Obezite cerrahisi sonrasında yeni taş gelişimi de yüksek oranlarda bildirilmektedir. Bu çalışmada Laparoskopik Sleeve Gastrektomi (LSG) ameliyatı sonrası gelişebilecek safra kesesi taşı ve/veya komplikasyonlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Ankara Atatürk Eğitim ve Araştırma Hastanesinde Ocak 2013 ile Aralık 2016 yılları arasında LSG ameliyatı yapılan 68 hastanın dosyası retrospektif olarak incelendi. Bulgular: LSG ameliyatı olan kadın hastaların ortalama yaşı 42,95±10,72 yıl, erkek hastaların ortalama yaşı 36,23±10,76 yıldır. Ameliyat öncesi kadın hastalarda vücut kütle indeksi (VKİ) ortalaması 45,26±3,58 kg/m2, erkeklerde 47,58±7,74 kg/m2 iken ameliyattan iki yıl sonrasında VKİ ortalaması kadınlarda 27,18±2,80 kg/m2, erkeklerde 27,92±3,79 kg/m2 ye düştüğü saptandı (p<0,001). LSG operasyonu geçiren hastaların 17(%31)’sinde safra kesesi taşı veya çamuru saptandı. Postoperatif safra kesesi taşı gelişen hastalardan birisinde (%5,88) akut kolesistit geliştiği bulundu. LSG ameliyatı sonrası hastalar kilo kaybı açısından karşılaştırıldıklarında safra taşı gelişen ve gelişmeyenler arasında istatistiksel olarak anlamlı bir farklılık saptanmadı (p=0,065). Sonuç: LSG ameliyatı yapılacak hastalardan semptomatik kolelitiazis şikayeti olmayan hastalara laparoskopik kolesistektomi (LK) yapılması gerekmedi. LSG ameliyatı sonrası safra kesesinde yeni taş gelişmesi yüksek oranda bulundu. Bununla birlikte bu taşlar erken dönemde semptom vermediği için LSG hastalarının düzenli kontrolünün yapılmasının semptomatik kolelitiazis insidansını azaltacağı kanaatindeyiz.

Anahtar Kelimeler:

Morbid Obezite, Laporoskopik Sleeve Gastrektomi, Safra Kesesi Taşları, Kolesistektomi

Prevalence of Symptomatic Cholelithiasis After Obesity Surgery and Timing of Surgical Treatment

Aim: 13% of adults are 18 years old and over, and comorbid diseases of obesity are on the increase in the World. Patients that reach standard weight after bariatric surgery show recovery in comorbid diseases. Gallbladder stone incidence rate increases with obesity. Development of stone after bariatric surgery is known to be on higher levels, as well. The objective of this study is to analyze the gallbladder stone and/or complications that may develop after Laparoscopic Sleeve Gastrectomy (LSG) surgery. Material and Methods: The medical files of 68 patients were retrospectively analyzed, who underwent LSG surgery between January 2013 and December 2016 in Ankara Atatürk Training and Research Hospital. Results: The age average of female patients that underwent LSG surgery is 42.95±10.72, while it is 36.23±10.76 for male patients. While the mean BMI (Body Mass Index) of female and male patients were respectively 45.26±3.58 kg/m2 and 47.58±7.74 kg/m2, this mean was found that BMI levels decreased to 27.18±2.80 kg/m2 for female patients and 27.92±3.79 kg/m2 for male patients (p<0.001). 17 (31%) of the patients, who underwent LSG surgery suffered from gallbladder stone or sludge. Acute cholecystitis was found in one (5.88%) of the patients who developed post-operative gallbladder stones. When the patients after LSG surgery were compared in terms of weight loss, no statistically significant difference was found between those with and without gallstones (p=0.065). Conclusion: Laparoscopic cholecystectomy (LC) was not required in patients who did not have symptomatic cholelithiasis. The rate of developing gallbladder stone after LSG surgery was found to be high. However, since these stones do not show any symptoms in the early period, we think that regular control of LSG patients will decrease the incidence of symptomatic cholelithiasis.

Keywords:

Morbid obesity, Laparoscopic sleeve gastrectomy, Gallstones, Cholecystectomy,

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