Vol:.(1234567890) Surgical Endoscopy (2022) 36:6396–6402 https://doi.org/10.1007/s00464-021-08980-3 1 3 Ursodeoxycholic acid for the prevention of gall stones after laparoscopic sleeve gastrectomy: a prospective controlled study Mohamed AbdAlla Salman 1  · Ahmed Salman 2  · Usama Shaker Mohamed 1  · Ahmed Mahmoud Hussein 1  · Mahmoud A. Ameen 1  · Haitham S. E. Omar 1  · Ahmed Elewa 3  · Ahmed Hamdy 3  · Abd Al‑Kareem Elias 4  · Mohamed Tourky 5  · Alaa Helal 5  · Ahmed Abdelrahman Mahmoud 5  · Feras Aljarad 6  · Ahmed Moustafa 7  · Hossam El‑Din Shaaban 8  · Ahmed Nashaat 9  · Amr Mahmoud Hussein 10  · Tamer Omar 3  · Hany Balamoun 1 Received: 18 August 2021 / Accepted: 31 December 2021 / Published online: 12 January 2022 © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022 Abstract Background Obesity is a risk factor for cholelithiasis. Besides, rapid weight loss after bariatric surgery upsurges the rate of cholelithiasis and acute cholecystitis. This study aimed to compare gallstone development frequency after LSG under ursodeoxycholic acid (UDCA) prophylaxis. Methods This prospective controlled study included 332 patients scheduled for LSG randomized to receive 500 mg UDCA daily for 12 months (UDCA Group) or no treatment (Control Group). Ultrasonography was done 6 and 12 months after surgery to detect gallstones. Cholecystectomy was done for complicated cases of cholelithiasis. Results Seventy-one patients were lost to follow-up, and 3 developed severe adverse efects of UDCA and excluded. Data are presented for 130 patients in the UDCA group and 128 in the Control group. Collectively, 11 patients (8.5%) of the UDCA group and 41 (32.0%) of the Control group developed gall stones during the frst postoperative year (p < 0.001). Cholecystectomy was indicated in 3 patients (2.3%) of the UDCA group and 9 (7.0%) of the Control group (p = 0.072). On multivariate analysis, higher BMI, dyslipidemia, and lacking UDCA prophylaxis were the independent factors signifcantly associated with stone development. Also, stone development was associated with higher weight loss after 6 and 12 months. Conclusion UDCA 500 mg once daily for 12 months after LSG is efective in reducing gallstone formation at 1 year. UDCA administration reduced the frequency of cholecystectomies from 7 to 2.3%. High BMI and dyslipidemia are the independent preoperative factors signifcantly associated with stone development. The global obesity epidemic continues to advance and grasp more of the world population. It is currently afecting more than 2 billion people [1]. Obesity is a major risk factor for many diseases, particularly diabetes mellitus, cardiovascu- lar disorders, and cancer [2], and the list is expanding. A Mendelian randomization study has demonstrated a causal association between high body mass index (BMI) and gall- stone formation [3]. Patients with morbid obesity have a 3–5 times higher risk of gallstone formation [4, 5]. Bariatric surgery is estab- lished as an efective and sustainable method of weight loss and improvement of obesity-related diseases [6]. Despite its safety, bariatric procedures may lead to some complica- tions. After surgery, rapid weight loss upsurges the rate of cholelithiasis and acute cholecystitis [4, 7, 8]. Over 10 years after bariatric surgery, gallstone formation was detected in 17.4% of the patients [9]. In a retrospective analysis, the incidence of cholelithiasis and symptomatic gallstones after laparoscopic sleeve gastrectomy (LSG) was 47.9% and 22.9%, respectively [10]. In another retrospective study including 1397 patients subjected to various bariatric pro- cedures, postoperative gallstone development incidence was 8.4% after LSG [8]. Prophylactic laparoscopic cholecystectomy (LC) was sug- gested to prevent gallstone formation after bariatric surgery. However, this policy is a matter of controversy [11]. The procedure may be technically challenging as the gallbladder may be engulfed by the large liver [12]. The difculty can be increased if the gallbladder is thickened, fbrosed, and adherent [13]. Worni et al. reported increased morbidity and mortality if bariatric surgery was combined by cholecystec- tomy [14]. and Other Interventional Techniques * Mohamed AbdAlla Salman Mohammed.salman@kasralainy.edu.eg Extended author information available on the last page of the article Content courtesy of Springer Nature, terms of use apply. Rights reserved.