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This article is part of the supplement: Selected articles from the XXV National Congress of the Italian Society of Geriatric Surgery

Open Access Research article

Morpho-functional gastric pre-and post-operative changes in elderly patients undergoing laparoscopic cholecystectomy for gallstone related disease

Giovanni Aprea1*, Alfonso Canfora1, Antonio Ferronetti1, Antonio Giugliano1, Francesco Guida1, Antonio Braun1, Melania Battaglini Ciciriello1, Federica Tovecci1, Giovanni Mastrobuoni1, Fabrizio Cardin2 and Bruno Amato1

Author affiliations

1 Department of General, Geriatric, Oncologic Surgery and Advanced Technologies, University “Federico II” of Naples, Via Pansini, 5 - 80131 – Naples, Italy

2 Department of Surgical and Gastroenterological Sciences, Padova University Hospital, Italy Via Giustiniani n.2, 35126 Padova, Italy

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Citation and License

BMC Surgery 2012, 12(Suppl 1):S5  doi:10.1186/1471-2482-12-S1-S5

Published: 15 November 2012

Abstract

Background

Cholecystectomy, gold standard treatment for gallbladder lithiasis, is closely associated with increased bile reflux into the stomach as amply demonstrated by experimental studies. The high prevalence of gallstones in the population and the consequent widespread use of surgical removal of the gallbladder require an assessment of the relationship between cholecystectomy and gastric mucosal disorders.

Morphological evaluations performed on serial pre and post – surgical biopsies have provided new acquisitions about gastric damage induced by bile in the organ.

Methods

62 elderly patients with gallstone related disease were recruited in a 30 months period. All patients were subjected to the most appropriate treatment (Laparoscopic cholecystectomy). The subjects had a pre-surgical evaluation with:

• dyspeptic symptoms questionnaire,

• gastric endoscopy with body, antrum, and fundus random biopsies,

• histo-pathological analysis of samples and elaboration of bile reflux index (BRI).

The same evaluation was repeated at a 6 months follow-up.

Results

In our series the duodeno-gastric reflux and the consensual biliary gastritis, assessed histologically with the BRI, was found in 58% of the patients after 6 months from cholecystectomy. The demonstrated bile reflux had no effect on H. pylori’s gastric colonization nor on the induction of gastric precancerous lesions.

Conclusions

Cholecystectomy, gold standard treatment for gallstone-related diseases, is practiced in a high percentage of patients with this condition. Such procedure, considered by many harmless, was, in our study, associated with a significant risk of developing biliary gastritis after 6 months during the postoperative period.