Introduction
Laparoscopic cholecystectomy is well known as a gold standard of treatment for gallstone disease. It has been implied that cholecystectomy is an independent risk factor for metabolic syndrome. Nevertheless, evidence on metabolic outcomes of cholecystectomy is based chiefly on population-based retrospective research and remains inconclusive.
Aims & Methods
The study aims to assess the risk of metabolic syndrome after laparoscopic cholecystectomy prospectively and evaluate the change in serum lipid levels associated with gallbladder removal. The study included individuals undergoing laparoscopic cholecystectomy due to gallstones. The exclusion criteria covered all previous metabolic disorders and influencing drugs. The changes in all metabolic syndrome criteria were evaluated before and three months after the laparoscopic cholecystectomy. The blood evaluation contained serum glucose, total serum cholesterol (TC), low-density (LDL) and high-density lipoprotein cholesterol (HDL), and triglyceride levels (TG). The medical examination evaluated blood pressure (BP), heart rate (HR), weight, and waist circumference. The study was approved by the local ethics committee and was registered on ClinicalTrails.gov. (NCT05557669).
Results
85 participants were enrolled. There were no statistically significant differences postoperatively in weight, body mass index, BP, HR, serum glucose, and TG. Although, there was a remarkable decrease in both TC and LDL levels. HDL increased notably. The prevalence of the MetS changed insignificantly after surgery. The notably lower percentage of individuals after surgery fulfilled the fasting plasma glucose criterion, but other criteria changed unremarkably. The relative risk of developing MetS after laparoscopic cholecystectomy was 0,87 (0.64-1.19; CI 95%).
Table 1. Relative risk (CI 95%) of developing different metabolic syndrome criteria after laparoscopic cholecystectomy.
| Criteria | RR | CI 95% |
Fasting plasma glucose
| 0.83
| 0.61-1.11 |
Waist circumference
| 0.98 | 0.71-1.33 |
| TG | 1.12 | 0.75-1.66 |
| HDL | 0.89 | 0.62-1.28
|
BP
| 1.00 | 0.72-1.38
|
Conclusion
In contrast to retrospective studies, the prospective evaluation indicated no evidence of increased risk of metabolic syndrome after laparoscopic cholecystectomy. However, further investigation regarding the metabolic consequences of this procedure is required.
References
Latenstein CSS, Alferink LJM, Darwish Murad S, et al. The Association Between Cholecystectomy, Metabolic Syndrome, and Nonalcoholic Fatty Liver Disease: A Population-Based Study. Clin Transl Gastroenterol. 2020 Apr;11(4):e00170. PMID: 32352682;
Yue, W., Sun, X. & Du, T. Cholecystectomy versus central obesity or insulin resistance in relation to the risk of nonalcoholic fatty liver disease: the third US National Health and Nutrition Examination Survey. BMC Endocr Disord 19, 95 (2019).
Chen Y, Wu S, Tian Y. Cholecystectomy as a risk factor of metabolic syndrome: from epidemiologic clues to biochemical mechanisms. Lab Invest. 2018 Jan;98(1):7-14. PMID: 28892095.
Lefebvre P, Cariou B, Lien F, Kuipers F, Staels B. Role of bile acids and bile acid receptors in metabolic regulation. . Physiol Rev. 2009 Jan;89(1):147-91. PMID: 19126757.
Garruti G, Wang DQ, Di Ciaula A, Portincasa P. Cholecystectomy: a way forward and back to metabolic syndrome? Lab Invest. 2018 Jan;98(1):4-6. PMCID: PMC8114797.
Lyu J, Lin Q, Fang Z, Xu Z, Liu Z. Complex impacts of gallstone disease on metabolic syndrome and nonalcoholic fatty liver disease. Front Endocrinol (Lausanne). 2022 Nov 23;13:1032557. PMID: 36506064;