Surgical Approach Affects Risk of Gallstones after Gastrectomy

NEW YORK NOV 29, 2005(Reuters Health) - The increased risk of gallstones after gastrectomy is influenced by several surgical factors, according to a report in the November issue of the British Journal of Surgery.

The cause of the increased incidence of gallstones after gastrectomy is unknown, Dr. Tsunehiro Kobayashi from the University of Alberta, Edmonton, Canada and colleagues note. They investigated risk factors for the development of gallstones after gastrectomy for gastric cancer in 749 patients who underwent gallbladder ultrasonography at some time after surgery.

Eighty-six patients were diagnosed with gallstones, the team reports, for a 5-year incidence of 13.6% and 10-year incidence of 22.1%.

"These results are consistent with other reports of at least a 10% higher incidence of gallstones in people who have undergone gastrectomy than in the general population," the investigators write.

The mean time between gastrectomy and diagnosis of gallstones was 41.3 months, the results indicate.

Gallstones were significantly more common in patients who underwent total compared with partial gastrectomy and in patients whose reconstructions excluded the duodenum, the researchers note.

In a multivariate analysis, lymph node dissection in the hepatoduodenal ligament, pylorus-preserving near-total gastrectomy, and Roux-en-Y reconstruction were significant risk factors for gallstones after gastrectomy.

"Most patients who develop gallstones after gastrectomy in this study were asymptomatic and fewer than 0.5% required cholecystectomy," the authors comment. "Preventive cholecystectomy therefore appears to be unnecessary."

SOURCE:

• Br J Surg 2005;92:1399-1403.