24 Jul

Changes in gallbladder motility and gallstone formation following laparoscopic gastric banding: DISCUSSION (Part 4)

The advantages of laparascopic gastric banding include a shortened hospitalization and a quicker return to normal oral intake and activity after surgery. The preservation of the normal anatomy of the gastrointestinal tract and of the entero-hepatic circulation of bile salts should lessen the predisposition towards gallstone formation. Bile salts secretion is the driving force for bile formation, and with phospholipids, is essential for cholesterol solubilization.

Generally, the liver of an obese person secretes cholesterol excessively. Rapid weight loss further aggravates this cholesterol hypersecretion, likely through its mobilization from fat. Reduced intake, especially in the weeks following restrictive bariatric surgery, results in less frequent and less effective stimulation of the gallbladder to empty. These conditions cause bile to become more supersaturated with cholesterol because of depressed enterohepatic cycling of bile salts, which lowers their hepatic secretion, and also because of the excessive cholesterol being secreted.

Further, bile resides for longer periods in the gallbladder, allowing the necessary time for nucleation and the precipitation of cholesterol microcrystals, crystal aggregation and stone growth. The laparoscopic procedure aims to provide earlier feeding and gradual weight loss compared with the gastric bypass operation, but did not prevent stone formation in those patients with excessive rates of weight reduction. Although the numbers in this study are not large, the incidence of gallstones (three out of 11 patients, or 27%) is somewhat less than that after gastric bypass surgery for obesity (36% to 50%), but is similar to that from dietary therapy. Best quality drugs are waiting – purchase cialis online pharmacy to spend less time and money.

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