Sallum RAA, Padrão EMH, Szachnowicz S, Seguro FCBC, Bianchi ET, Cecconello I. Prevalence of gallstones in 1,229 patients submitted to surgical laparoscopic treatment of GERD and esophageal achalasia: associated cholecystectomy was a safe procedure.
Arq Bras Cir Dig 2016;
28:113-6. [PMID:
26176247 PMCID:
PMC4737332 DOI:
10.1590/s0102-67202015000200007]
[Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/08/2015] [Indexed: 12/23/2022]
Abstract
Background
Association between esophageal achalasia/ gastroesophageal reflux disease (GERD)
and cholelithiasis is not clear. Epidemiological data are controversial due to
different methodologies applied, the regional differences and the number of
patients involved. Results of concomitant cholecistectomy associated to surgical
treatment of both diseases regarding safety is poorly understood.
Aim
To analyze the prevalence of cholelithiasis in patients with esophageal achalasia
and gastroesophageal reflux submitted to cardiomyotomy or fundoplication. Also, to
evaluate the safety of concomitant cholecistectomy.
Methods
Retrospective analysis of 1410 patients operated from 2000 to 2013. They were
divided into two groups: patients with GERD submitted to laparocopic hiatoplasty
plus Nissen fundoplication and patients with esophageal achalasia to laparoscopic
cardiomyotomy plus partial fundoplication. It was collected epidemiological data,
specific diagnosis and subgroups, the presence or absence of gallstones, surgical
procedure, operative and clinical complications and mortality. All
groups/subgroups were compared.
Results
From 1,229 patients with GERD or esophageal achalasia, submitted to laparoscopic
cardiomyotomy or fundoplication, 138 (11.43%) had cholelitiasis, occurring more in
females (2.38:1) with mean age of 50,27 years old. In 604 patients with GERD, 79
(13,08%) had cholelitiasis. Lower prevalence occurred in Barrett's esophagus
patients 7/105 (6.67%) (p=0.037). In 625 with esophageal achalasia, 59 (9.44%) had
cholelitiasis, with no difference between chagasic and idiopathic forms (p=0.677).
Complications of patients with or without cholecystectomy were similar in
fundoplication and cardiomyotomy (p=0.78 and p=1.00).There was no mortality or
complications related to cholecystectomy in this series.
Conclusions
Prevalence of cholelithiasis was higher in patients submitted to fundoplication
(GERD). Patients with chagasic or idiopatic forms of achalasia had the same
prevalence of cholelithiasis. Gallstones occurred more in GERD patients without
Barrett's esophagus. Simultaneous laparoscopic cholecystectomy was proved
safe.
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