Prevalence of gallstones in 1,229 patients submitted to surgical laparoscopic treatment of GERD and esophageal achalasia: associated cholecystectomy was a safe procedure

BACKGROUND: Association between esophageal achalasia/ gastroesophageal reflux disease (GERD) and cholelithiasis is not clear. Epidemiological data are controversial due to different methodologies applied, the regional differences and the number of patients involved. Results of concomitant cholecistectomy associated to surgical treatment of both diseases regarding safety is poorly understood. AIM: To analyze the prevalence of cholelithiasis in patients with esophageal achalasia and gastroesophageal reflux submitted to cardiomyotomy or fundoplication. Also, to evaluate the safety of concomitant cholecistectomy. METHODS: Retrospective analysis of 1410 patients operated from 2000 to 2013. They were divided into two groups: patients with GERD submitted to laparocopic hiatoplasty plus Nissen fundoplication and patients with esophageal achalasia to laparoscopic cardiomyotomy plus partial fundoplication. It was collected epidemiological data, specific diagnosis and subgroups, the presence or absence of gallstones, surgical procedure, operative and clinical complications and mortality. All groups/subgroups were compared. RESULTS: From 1,229 patients with GERD or esophageal achalasia, submitted to laparoscopic cardiomyotomy or fundoplication, 138 (11.43%) had cholelitiasis, occurring more in females (2.38:1) with mean age of 50,27 years old. In 604 patients with GERD, 79 (13,08%) had cholelitiasis. Lower prevalence occurred in Barrett's esophagus patients 7/105 (6.67%) (p=0.037). In 625 with esophageal achalasia, 59 (9.44%) had cholelitiasis, with no difference between chagasic and idiopathic forms (p=0.677). Complications of patients with or without cholecystectomy were similar in fundoplication and cardiomyotomy (p=0.78 and p=1.00).There was no mortality or complications related to cholecystectomy in this series. CONCLUSIONS: Prevalence of cholelithiasis was higher in patients submitted to fundoplication (GERD). Patients with chagasic or idiopatic forms of achalasia had the same prevalence of cholelithiasis. Gallstones occurred more in GERD patients without Barrett's esophagus. Simultaneous laparoscopic cholecystectomy was proved safe.

背景：食管贲门失弛缓症（esophageal achalasia）与胃食管反流病（GERD）和胆石症（cholelithiasis）之间的关联尚不明确。由于所采用的研究方法、地域差异以及纳入患者数量的不同，现有流行病学数据存在争议。针对两种疾病联合外科治疗时同期行胆囊切除术（cholecystectomy）的安全性相关研究结果，目前仍知之甚少。
目的：分析接受贲门肌切开术（cardiomyotomy）或胃底折叠术（fundoplication）的食管贲门失弛缓症及胃食管反流病患者中胆石症的患病率，并评估同期行胆囊切除术的安全性。
方法：对2000年至2013年期间接受手术的1410例患者进行回顾性分析。将患者分为两组：其一为接受腹腔镜（laparoscopic）食管裂孔修补术（hiatoplasty）联合尼森胃底折叠术（Nissen fundoplication）的胃食管反流病患者，其二为接受腹腔镜贲门肌切开术联合部分胃底折叠术的食管贲门失弛缓症患者。收集的资料包括流行病学数据、特异性诊断及亚组情况、是否合并胆囊结石、手术方式、手术及临床并发症和死亡率，并对所有组/亚组进行比较。
结果：在1229例接受腹腔镜贲门肌切开术或胃底折叠术的胃食管反流病或食管贲门失弛缓症患者中，138例（11.43%）合并胆石症，其中女性患者占比更高（女:男≈2.38:1），平均年龄为50.27岁。在604例胃食管反流病患者中，79例（13.08%）合并胆石症；巴雷特食管（Barrett's esophagus）患者的胆石症患病率更低，为7/105（6.67%，P=0.037）。在625例食管贲门失弛缓症患者中，59例（9.44%）合并胆石症，查加斯型与特发性（idiopathic）贲门失弛缓症患者的胆石症患病率无显著差异（P=0.677）。在胃底折叠术组与贲门肌切开术组中，是否行胆囊切除术的患者并发症发生率均无显著差异（P分别为0.78和1.00）。本研究系列中未出现与胆囊切除术相关的死亡或并发症病例。
结论：接受胃底折叠术的胃食管反流病患者胆石症患病率更高。查加斯型与特发性贲门失弛缓症患者的胆石症患病率无差异。无巴雷特食管的胃食管反流病患者更易合并胆囊结石。同期腹腔镜胆囊切除术被证实具有安全性。