Ursodeoxycholic acid for the prevention of gall stones after laparoscopic sleeve gastrectomy: a prospective controlled study.

BACKGROUND: Obesity is a risk factor for cholelithiasis. Besides, rapid weight loss after bariatric surgery upsurges the rate of cholelithiasis and acute cholecystitis. This study aimed to compare gallstone development frequency after LSG under ursodeoxycholic acid (UDCA) prophylaxis. METHODS: This prospective controlled study included 332 patients scheduled for LSG randomized to receive 500 mg UDCA daily for 12 months (UDCA Group) or no treatment (Control Group). Ultrasonography was done 6 and 12 months after surgery to detect gallstones. Cholecystectomy was done for complicated cases of cholelithiasis. RESULTS: Seventy-one patients were lost to follow-up, and 3 developed severe adverse effects of UDCA and excluded. Data are presented for 130 patients in the UDCA group and 128 in the Control group. Collectively, 11 patients (8.5%) of the UDCA group and 41 (32.0%) of the Control group developed gall stones during the first postoperative year (p < 0.001). Cholecystectomy was indicated in 3 patients (2.3%) of the UDCA group and 9 (7.0%) of the Control group (p = 0.072). On multivariate analysis, higher BMI, dyslipidemia, and lacking UDCA prophylaxis were the independent factors significantly associated with stone development. Also, stone development was associated with higher weight loss after 6 and 12 months. CONCLUSION: UDCA 500 mg once daily for 12 months after LSG is effective in reducing gallstone formation at 1 year. UDCA administration reduced the frequency of cholecystectomies from 7 to 2.3%. High BMI and dyslipidemia are the independent preoperative factors significantly associated with stone development.

Correlation Between Preoperative Gastric Volume and Weight Loss After Laparoscopic Sleeve Gastrectomy.

PURPOSE: Long-term studies reported inadequate weight loss or weight regain after laparoscopic sleeve gastrectomy (LSG). This study investigated a possible relationship between preoperative gastric volume (GV) measured by CT volumetry and weight loss one year after LSG. METHODS: This prospective study included 120 patients scheduled for LSG. 3D CT gastric volumetry was done before surgery. The weight loss in the first year was serially recorded. The primary outcome measure was the correlation between preoperative GV and postoperative weight loss after one year. The secondary outcomes were the correlation between preoperative GV and other patients' characteristics as age and body mass index (BMI). RESULTS: Weight and BMI decreased significantly up to 12 months. The percentage of excess weight loss (%EWL) at 6 and 12 months was significantly higher than at three months. Preoperative GV was 1021 ± 253, ranging from 397 to 1543 mL. GV was not related to sex, age, weight, height, postoperative weight, and BMI. CONCLUSION: Preoperative gastric volume cannot predict weight loss one year after LSG. It is not correlated with age, sex, or preoperative weight, and BMI.

What defines a good website of a Department of Obstetrics and Gynecology? A user survey.

PURPOSE: The Internet has become a widely used source of healthcare information. Many Departments of Obstetrics and Gynecology use their websites for public relations purposes. It is, however, unclear, what relevant stakeholders such as patients, relatives of patients, physicians, and medical students expect of an Obstetrics and Gynecology Department's website. Therefore, we evaluated the opinions and expectations of the various stakeholders using a structured questionnaire. METHODS: We asked gynecologic patients, obstetric patients, relatives of patients, medical students, and physicians to fill in an anonymous questionnaire consisting of general facts about the informant, one open-ended question on expectations and wishes regarding the website, and 28 rating scale questions (7-step visual analog scale ranging from, not important' to, very important') covering the topics "website navigation" (4 questions), "first contact" (3 questions), "clinic processes" (7 questions), "facts and figures about the Department" (4 questions), "visual impressions" (5 questions), and "obstetrics-specific items" (5 questions). Questionnaires for physicians included four additional questions about the value of Department websites as an information tool for themselves and their patients. We used descriptive statistics to analyze the data. RESULTS: 1458 questionnaires were analyzed (gynecologic patients, n = 615 [42%]; obstetric patients, n = 479 [33%]; relatives of patients, n = 77 [5%]; medical students n = 238 [16%]; physicians, n = 41 [3%]). The number of circulated questionnaires was not recorded and thus, the response rate is unknown. 1304 (89%) respondents used the Internet as a regular source of health care information, 642 (44%) had previously searched an Obstetrics and Gynecology Department website. All respondents rated contact data and information about processes in the clinic highest; whereas, other issues such as medical facts, visual impressions, and website design issues were significantly less important. Pregnant women rated contact information and obstetric facts highest. 90% of physicians regularly used Department websites for patient referrals and rated contact information and medical team details most important. CONCLUSIONS: When designing a website of an Obstetrics and Gynecology Department, contact information and information about processes in the clinic should be displayed most prominently and be easily accessible. Subsections specifically targeted at obstetric patients and physicians should be provided.