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Pattern of Biliary Disease Following Laparoscopic Sleeve Gastrectomy in Adolescents
Author(s) -
Tashiro Jun,
Thenappan Arunachalam A.,
Nadler Evan P.
Publication year - 2019
Publication title -
obesity
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.438
H-Index - 199
eISSN - 1930-739X
pISSN - 1930-7381
DOI - 10.1002/oby.22634
Subject(s) - medicine , gallstones , biliary colic , cholecystectomy , sleeve gastrectomy , gastroenterology , weight loss , etiology , biliary disease , perioperative , pancreatitis , acute pancreatitis , obesity , general surgery , surgery , gastric bypass
Objective The use of laparoscopic sleeve gastrectomy (LSG) has risen steadily as a treatment for adolescents with obesity. This study determined whether obstructive biliary complications after rapid, LSG‐related weight loss occur similarly in adolescents compared with adults. Methods Between 2010 and 2019, 309 patients underwent LSG. Demographics and clinical factors, including pre‐ and perioperative BMI and weight changes, were included. Results Overall, 21 patients (7%) had post‐LSG biliary disease (BD), of whom 13 presented with acute pancreatitis (AP) and 8 with biliary colic. No differences existed between those with BD ( n = 21) and the remaining cohort ( n = 288). Patients with BD were 16.3 (SD 2.4) years of age at LSG, with a preoperative BMI of 49.3 (SD 6.7) kg/m 2 . Preoperative excess BMI loss was 7.1% (SD 11.3%). An ultrasound revealed gallstones (71%) and sludge or crystals (12%). Eighteen patients underwent cholecystectomy between 4 weeks and 29 months after LSG. Conclusions Pediatric patients present with BD at a similar rate after LSG compared with adults. The majority of adolescents, however, manifest with AP. Thus, pancreatitis should be high on the differential diagnosis list when evaluating post‐LSG abdominal symptoms. Additional studies are warranted to elucidate the pathophysiology of post‐LSG AP for prevention in the future because its etiology may or may not be solely related to BD.