Changes in gallbladder motility and gallstone formation following laparoscopic gastric banding: DISCUSSION (Part 3)
The high refilling rate of the gallbladder may reflect a high rate of hepatic bile secretion – these large individuals empty a large bolus of bile salts into the small intestine that recycles via the enterohepatic circulation – and a relatively low intravesicular pressure (P) (from LaPlace’s law [P a 2T/r], the large gallbladder residual volume with its elevated radius [r] should be associated with a low intravesicular pressure for the same wall tension [T]). A third component, the sphincter of Oddi tone, if elevated, could enhance gallbladder filling, but there is no reason to suspect this.
The bariatric surgery performed to restrict intake resulted in a dramatic weight loss in all patients after six weeks. There was also a significant reduction in gallbladder emptying. The patients who developed gallstones were affected the most; their emptying fell outside of the 95th percentile of the group. All three patients who developed gallstones had a greater weight loss than that recommended for safe weight reduction. Two of these patients were out of the 95th percentile for the group. This rapid weight loss led to a depressed gallbladder emptying and a greater gallbladder residual volume. Further, the drop in the refilling rate likely reduced the turnover of gallbladder bile, aggravating stasis.
The lowered emptying might have depressed the enterohepatic recycling of bile salts, reducing their flux through the liver and perhaps contributing to a relative higher cholesterol content in bile. The result was gallstone formation in these patients following surgery; particularly associated with brisk weight loss. After six months, all gallbladder parameters began to normalize, with gallstones disappearing in one of the patients who had exhibited a significant improvement in all parameters, especially gallbladder emptying. These apparently beneficial changes occurred despite these patients still being obese, likely reflecting the more modest rate of weight reduction. Most advantageous shopping – purchase cialis online for everyone to spend less.