Abstract
Obesity is currently an important and increasing social and health problem. The prevalence of obesity among men is around 20-25% and among women 25-40%. Patients with a body mass index (BMI) < 40, called as well simple obesity, diet should be tried first to lose weight but in patients with a BMI >40, (morbid obesity) and patients with supermorbid obesity bariatric surgery is indicated.Bariatric Surgery is a subspecialty of General Surgery focused on the surgical approach of obesity. This kind of surgery was first started in 1957 at the University of Minnesota. Since then the surgical techniques used have also changed. The first techniques used was intestinal bypass, this approach was effective, because weight loss was significative but was associated with a considerable morbidity related to the metabolic and endocrine changes related to surgery, causing important micronutrient and vitamin deficiencies.
Others approaches have been developed afterwards and used depending of the obesity type, BMI and pattern of eating of the patient. These techniques have been classified as: restrictive techniques (Vertical banded gastroplasty, Laparoscopic Lap-band), derivative techniques (Y de Roux), malabsortive techniques (Scopinaro) and complex techniques (Salmon, Fobbi-Capella).
Gallstones are commonly found among the population and the diagnosis of gallstones is increasing since the use of abdominal ultrasound. Fifty per cent of the patients are symptom- free, less than 30 % of the patients have symptoms and only 20% of the patients develop complications. The prevalence of gallstones is higher among obese patients and particularly higher in women. Gallstones formation is due to cholesterol deposits , mobilisation and posterior precipitation.
Fast weight loss due to severe hypocaloric diets or as a consequence of bariatric surgery predisposes to cholesterol precipitation in the gallbladder and the incidence of gallstones increases in this group of patients.
In our hospital (Hospital Universitari germans Trías i Pujol de Badalona, Barcelona, Spain) there is a specific unit dealing with Eating Disorders, treating patients either with simple obesity , morbid and supermorbid obesity candidates to surgery. All patients scheduled for bariatric surgery a routine abdominal ultrasound is performed preoperatively to detect gallstones. If gallstones are diagnosed a routine cholecystectomy is performed during bariatric surgery. If the abdominal ultrasound performed preoperative failed to show gallstones, then we suggest to study the bile preoperatively to detect cholesterol or calcium bilirrubinate micro-crystals. In these cases a 20-30 cc of bile are withdrawn, spined at 2000 revolutions per minute for ten minutes and then observed under optic microscope. If micro-crystals are found a routine cholecystectomy is indicated and performed during bariatric surgery.
Following this approach 170 patients with morbid obesity were operated. The procedure performed in all of them was a vertical banded gastroplasty plus cholecystectomy (in patients with gallstones found preoperatively in the abdominal ultrasound or with micro-crystals found in the bile under optic microscope examination). Only in 13 patients (7.6%) the cholecystectomy was not performed (microscopic bile examination and abdominal ultrasound was normal).
Sixty patients were classified as having supermorbid obesity, the surgical approach chosen to treat this group of patients was the Salomon technique (which includes cholecystectomy anyway).
We concluded that cholecystectomy (therapeutical/prophylactic) should be performed in all patients with morbid obesity submitted to surgical treatment.
| Date of Award | 1 Feb 2002 |
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| Original language | Spanish |
| Supervisor | Antonio Alastrué Vidal (Director) & Jaume Fernández-Llamazares Rodríguez (Director) |