Is Cholecystectomy in Patients with Symptomatic Uncomplicated Cholelithiasis Beneficial in Improving the Lipid Profile?

Effect of laparoscopic cholecystectomy on plasma levels of EETs, arachidonic acids derived lipid mediators

BACKGROUND

Epoxyeicosatrienoic acids (EETs) are closely associated with lipoprotein metabolism, and changes in lipid profiles potentially affect their levels and functions. Given the alterations in lipid metabolism after cholecystectomy, this study aimed to investigate the levels of four EET regioisomers (free and esterified) and lipid profiles in patients with cholelithiasis after laparoscopic cholecystectomy (LC) and explore correlations between these parameters.

METHODS

This prospective study involved 40 patients with symptomatic cholelithiasis who underwent LC. Plasma EETs and serum total cholesterol, triglyceride, high-density lipoprotein (HDL), very low-density lipoprotein, low-density lipoprotein, and body mass index (BMI) values were determined preoperatively and after 6 months of LC.

RESULTS

After LC, triglyceride and very low-density lipoprotein levels increased while TC decreased. BMI values increased significantly after the operation. Despite plasma EET levels decreasing remarkably after surgery, this change did not reach statistical significance. A significant correlation was observed between preoperative levels of 8,9- and 11,12-EET and pre-and post-operative HDL. There was a significant negative correlation between the EET levels measured before and after surgery and the change in BMI values.

CONCLUSIONS

In this study, we observed significant changes in lipid profile 6 months after LC. While HDL, low-density lipoprotein, and EET levels showed a decreasing trend post-surgery, this change was not statistically significant. This trend and their significant correlations may indicate a complex relationship between HDL and EET metabolism. In addition, the negative correlation between EET levels and BMI changes highlights the need for further research to elucidate the metabolic impact and weight regulation of EETs after LC.

The effect of cholecystectomy for symptomatic gall stone disease on hepatic steatosis using transabdominal ultrasonography: An observational prospective study

Objectives

Hepatic steatosis and gallstones are common in the general population, with risk factors being multifactorial. Experimental studies have shown that cholecystectomy increases hepatic steatosis and leads to non-alcoholic fatty liver disease (NAFLD). In order to evaluate this, the current study was carried out in the department of general surgery at a medical school, in the north of India.

Material and Methods

One hundred and three patients awaiting cholecystectomy were selected after written informed consent. Their baseline characteristics were captured preoperatively and thereafter followed at 3rd month with liver function test (LFT), lipid profile and ultrasound (USG) abdomen.

Results

Average age of the patients enrolled was 41.62 ± 13.62 years and mean body mass index (BMI) was 25.96 ± 1.73 kg/m2 . Total bilirubin (0.56 vs 0.76, p <0.0001) and direct bilirubin (0.15 vs 0.27, p <0.0001) decreased significantly post cholecystectomy as compared to preoperative values. Levels of serum glutamic-oxaloacetic transaminase (SGOT) (49.14 vs 34.98 IU/dL), serum glutamic-pyruvic transaminase (SGPT) (50.85 vs 35.46 IU/dL) and alkaline phosphatase (ALP) (101.16 vs 85.97 IU/dL) increased significantly post-surgery. Cholesterol values (146.28 vs 168.77 mg/dL), triglycerides (TGs) (119 vs 133.56 mg/dL), low density lipoprotein (LDL) (93.32 vs 113.05 mg/dL) and very low density lipoprotein (VLDL) (18.68 vs 27.45 mg/dL) decreased significantly while high density lipoprotein (HDL) (48.96 vs 42.42 mg/dL) increased significantly at three month follow-up. Prevalence of fatty liver increased post operatively with a rise in Grade 1 steatosis (75%). Severity of fatty liver increased with (8.73%) Grade 3 steatosis on USG post-surgery. Hence, new patients with formerly normal USG reports developed fatty liver and those with preexisting liver steatosis seemed to worsen.

Conclusion

The study concluded that the prevalence of fatty liver increased post-cholecystectomy. Lipid profile parameters improved favorably with a decline in total cholesterol, TG, LDL and VLDL versus increase in HDL. LFT parameters also changed significantly.

Roles of ursodeoxycholic acid in the bile biochemistry and metabolomics in patients with choledocholithiasis: a prospective study

INTRODUCTION

Recurrence after the endoscopic treatment of common bile duct stones (CBDS) is related to bile metabolism and bile compositions. Ursodeoxycholic acid (UDCA) has been proved effective in reducing the recurrence of CBDS. However, the detailed effects of UDCA on bile metabolism are still not extensively explored.

OBJECTIVES

This study aimed to analyze the role of UDCA in patients with choledocholithiasis (CDC) from the perspective of biochemistry and metabolomics.

METHODS

A total of 89 patients with CDC who underwent endoscopic retrograde cholangiopancreatography were prospectively examined and randomly assigned to control and UDCA groups. The biochemical detections (cholesterol, bilirubin, and so on) were performed on the collected bile. Moreover, the metabolomics analysis was conducted based on bile from 20 patients in the UDCA group.

RESULTS

The bile levels of cholesterol and endotoxins significantly decreased after UDCA treatment. Regarding bile metabolomics, the levels of 25 metabolites changed significantly after UDCA treatment. The pathway enrichment analysis showed that the UDCA addition evoked a common response related to phenylalanine, tyrosine, and tryptophan biosynthesis; phenylalanine metabolism; arachidonic acid metabolism; and terpenoid backbone biosynthesis.

CONCLUSIONS

UDCA treatment within a short time interval (7 days) did not improve the circulating laboratory values in patients with CDC who had undergone endoscopy surgery. However, relevant decreases in the bile levels of cholesterol and endotoxin were observed. UDCA evoked a common response related to lipid metabolism and amino acid metabolism, which probably reduced the bile level of cholesterol, protected hepatocytes, and corrected the abnormality of lipid metabolism caused by CDC.

Blood lipid metabolism and the risk of gallstone disease: a multi-center study and meta-analysis

Background

Gallstone disease (GSD) is a common and costly biliary disorder. Multiple studies have investigated the associations between blood lipid metabolism and GSD risk; however, the results are inconsistent. This research aimed to comprehensively evaluate the relationships among serum total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and GSD risk.

Methods

Firstly, a multi-center cross-sectional study was carried out. Subjects who participated in the health examination in three hospitals between January 2015 and May 2020 were recruited. Multivariable logistic regression was used to investigate blood lipid metabolism associated with GSD risk. Then, a meta-analysis was performed to verify the associations further. Medline and Embase databases were systematically searched before June 10, 2021. The DerSimonian and Laird random-effect model was utilized when the heterogeneity was high; otherwise, fixed-effect model was adopted.

Results

There were 548,934 eligible participants included in the multi-center study, and 45,392 of them were diagnosed with GSD. The results demonstrated that total cholesterol and HDL cholesterol were negatively associated with GSD risk in both high vs. low model and per mmol/L increase model, while triglyceride was positively associated with GSD risk in the per unit increase model. In the meta-analysis, 104 studies with approximately 3 million participants were finally included. The results verified that HDL cholesterol [odds ratio (OR) = 0.636, P = 5.97 × 10^− 16 in high vs low model; OR = 0.974, P = 6.07 × 10^− 05 in per unit model] and triglyceride (OR = 1.192, P = 3.47 × 10^− 05 in high vs. low model; OR = 1.011, P = 5.12 × 10^− 05 in per unit model) were related to GSD risk in the two models.

Conclusions

The findings indicated that low HDL cholesterol levels and high triglyceride levels were risk factors for GSD. This study provides a basis for identifying the population at high risk for GSD and implementing tertiary prevention strategies for GSD, thus contributing to GSD prevention as well as disease burden relief.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12944-022-01635-9.