Gallstone Development After Gastrectomy

Kim, Yoon Jun; Kim, Byeong Gwan; Park, Dong Young; Lee, Han Chu; Yoon, Yong Bum; Song, In Sung; Kim, Chung Yong

Abstract

BACKGROUND/AIMS: Gallstone disease has been presumed to be a sequellae of gastrectomy. Although high incidences have been reported, it has not been conclusively shown that gastrectomized patients have a higher rate of gallstone formation and there has been no well organized studies about the prevalence and the complications of cholelithiasis after gastrectomy. The aim of this study was to evaluate the incidence of cholelithiasis after gastric resection, the cornplications of cholelithiasis, and high risk group for gallstone formation.
METHODS
The inclusion criteria were follow-up of more than 3 years, no cholelithiasis preoperatively by ultrasonography, and ultrasonographic postoperative control once a year at least and a total of 302 patients who had undergone gastrectomy at Seoul National University Hospital(S.N.U.H.) for gastric cancer between January 1, 1990 and December 31, 1991 were studied. The expected frequency of cholelithiasis was calculated, by sex and age, using prevalence data of an ultrasonographic result for gallstones of 366 visitors of S.N.U.H. Center for Health Promotion.
RESULTS
The 3-year cumulative incidence after gastrectomy was 10.8% in tnen and 10.1% in women. The 3-year postoperative point prevalence was 12.6% in men and 16.7% in women. Before surgery, the difference between the expected frequency and the observed frequency was not statistically significant(p>0.05) either in men or wotnen. After surgery, the observed frequency of gallstones was significantly higher than the expected frequency both in men(p=0.015) and women(p=0.02). The risk of cholelithiasis was significantly higher(p=0.019) in obese(body mass index>=25) patients, and the risk was independent of age, sex, and operation methods.
CONCLUSIONS
The 3-year postoperative point preva1ence of cholelithiasis was significantly higher than the expected frequency both in men and women. The risk of cholelithiasis was significantly higher in obese patients, and none of age, sex, and operation rnethods were risk factors. From these results, we suggest that prophylactic cholecystectomy should be considered at the time of gastrectomy and further study should be performed.