The role of Urso Deoxy Cholic Acid (UDCA) in cholelithiasis management after One Anastomosis Gastric Bypass (OAGB) for morbid obesity: results of a monocentric randomized controlled trial.

Obesity is related to multiple comorbidities, including metabolic syndromes, malignancies 4[1] and represents an important risk factor for the formation of gallstones 5. however, bariatric surgery leads to rapid weight loss, which is also a risk factor for gallstone formation. Ursodeoxycholic acid (UDCA) 600 mg/day was suggested as prophylaxis to reduce gallstone formation after diet-induced weight reduction [7–9]. The incidence of cholelithiasis appears to be different depending on the type of bariatric surgery that patients undergo [5–7]. Reported postoperative biliary complication rate requiring cholecystectomy is 0.9~7.5% after laparoscopic sleeve gastrectomy [8–10] and 6– 50% after laparoscopic gastric bypass [11, 12]. Moreover, there are bariatric surgery operations that do not allow an easy exploration of the duodenum like One Anastomosis gastric bypass(OAGB) or Roux and Y gastric bypass(RYGB), so the biliary tree may be endoscopically inaccessible, and surgery may be needed to have successful clearance of the biliary tree. Therefore, some surgeons recommend performing concomitant cholecystectomy for patients who undergo these kind of bariatric surgery 2[13–15]. Despite, the rate of adverse postoperative events after concomitant cholecystectomy during bariatric surgery has been reported to be significantly increased compared to patients undergoing bariatric alone. 5(6) increasing operative times, length of hospital stay, and morbidity and mortality rates [7, 10, 11]. The OAGB has had a widespread diffusion in recent years as a bariatric surgery, it is the third commonest bariatric procedure worldwide after sleeve gastrectomy (SG) [4], finding many supporters but also numerous criticisms in terms of problems related to biliary reflux and malabsorption. The purpose of this randomized monocentric study is to evaluate the incidence of gallstone formation after weight loss surgery and to detect the efficacy of 6 months regimen of prophylactic UDCA in the prevention of gallstones in patients underwent to OAGB