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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 21  |  Issue : 2  |  Page : 151-154

The effect of laparoscopic cholecystectomy on lipid profile


Department of Surgery, Al-Kindy Teaching Hospital, Baghdad, Iraq

Date of Submission16-Sep-2022
Date of Decision10-Oct-2022
Date of Acceptance11-Oct-2022
Date of Web Publication2-Jan-2023

Correspondence Address:
Dr. Ali Rodan Shuwelif
Al-Kindy Teaching Hospital, Baghdad
Iraq
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mj.mj_45_22

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  Abstract 

Background: Gallstone disease (GSD) is one of the most common surgical gastrointestinal diseases. Cholesterol is one of the constituents of gallstones. Hyperlipidemia and GSD are often linked to cholesterol in pathophysiology, and cholecystectomy is associated with hepatobiliary circulation affecting fat absorption. The aim of the study is to assess the lipid profile (LP) changes after laparoscopic cholecystectomy (LC). Methods: Prospective cohort study that included 200 patients with documented GSD and baseline measurement of LP, followed by LC for half of them, and two follow-up measurements of LP after 2 weeks and 1 month. Comparison of the LP between the two groups to estimate the difference that occur due to LC, after that, comparison of the two follow-up measurements with baseline to estimate the effect of these changes with time. Results: Total serum cholesterol (TC) and triglyceride level (TG) were significantly lower from control 1 month after surgery; on pairwise analysis, TG level was lower than baseline on both 2-week and 1-month follow-up measurements. High-density lipoprotein (HDL) was higher than the control after 1 month, on pairwise analysis at 2 weeks, no difference from baseline was found, and a significant difference was found after 1 month. Both low-density lipoprotein (LDL) and very LDL (VLDL) were not different from the control. Conclusion: LC is associated with a reduction of the serum level of both TC and TG and an increase serum level of HDL after 1 month of follow-up.

Keywords: Cholesterol, gallstone, hyperlipidemia, laparoscopic cholecystectomy, triglyceride


How to cite this article:
Shuwelif AR, Mihson HS, Maikhan AK. The effect of laparoscopic cholecystectomy on lipid profile. Mustansiriya Med J 2022;21:151-4

How to cite this URL:
Shuwelif AR, Mihson HS, Maikhan AK. The effect of laparoscopic cholecystectomy on lipid profile. Mustansiriya Med J [serial online] 2022 [cited 2023 Feb 8];21:151-4. Available from: https://www.mmjonweb.org/text.asp?2022/21/2/151/366634


  Introduction Top


Gallstone disease (GSD) is one of the most common surgical gastrointestinal diseases.[1] Although the exact incidence is unknown as the majority of cases were asymptomatic, the proposed incidence may reach up to 1.39 for every 100 person in the year.[2] Laparoscopic cholecystectomy (LC), the standard management of symptomatic gallstones, is one of commonly performed elective surgeries.[3] Biliary cholic or acute cholecystitis is the most common fates of GSD.[4] It is worthy to note that obese patients had a higher rate of having gallstones,[5] and cholesterol is one of the components of gallstones.[6] The mechanism that gallstones formed is multifactorial, the supersaturation of the cholesterol in bile is the most determinantal step. As cholesterol solubility in bile is dependent on the concentration of other components of bile (namely bile salt and phospholipids), at low concentrations of these components, cholesterol tends to be insoluble, forming a lithogenic nucleus for the gallstone.[7] Hyperlipidemia is a well-known risk factor for many cardiovascular morbidities.[8] The association of GSD with obesity raised the suspicion of pathological processes that link GSD and abnormal lipid profile (LP). Many studies had confirmed this concern.[9],[10] The opposite (GSD could induce dyslipidemia?) had been investigated and results had been linked to a common enemy, insulin resistance, making the gallbladder a metabolic regulatory organ,[11] that had its own rhythm in bile secretion,[12] that could be affected by LC.[13] These relations caught our attention to investigate the effect of cholecystectomy in the alteration of LP.

The aim of the study is to assess the LP changes after LC.


  Methods Top


A prospective cohort study was conducted at one of the major surgical hospitals over a period of 1 year (April 1, 2021, to April 1, 2022), the study included 200 participants of both sexes presented with symptomatic GSD that was diagnosed by abdominal ultrasound. All participants were candidates for LC. Cases with common bile duct stones, acute cholecystitis, familial hyperlipidemia, medical comorbidity, obese patients (body mass index >30 kg/m2), hematological diseases, patients on lipid-lowering agents, and pregnant patients were excluded from the study. The study group was divided into two groups each included 100 cases, the first group (Group A) were undergone LC, and the other group (Group B) were 100 cases that had an appointment for surgery for more than 1 month. All cases were interviewed, and detailed history and physical examination were done a day before surgery. All cases are advised to have a regular diet without modification.

For Group A, participants were fasting for 12 h then two milliliters of venous blood drown 1 day before surgery, 2 weeks, and 1 month after surgery. For Group B also, fasting samples were collected at starting day, after 2 weeks, and 1 month.

The same hospital laboratory was used with reporting the result of TC, TG, HDL, LDL, and VLDL.

Written consent was obtained from all participants, research proposal was approved by the scientific committee of the same hospital.

Statistical analysis: data were introduced to Microsoft Excel 365 and the statistical analysis was done using SPSS statistical analysis software (IBM company, Illinois, United States). Data were presented in the form of mean and standard deviation (±), counts, and percentages.

Comparison between the two groups to estimate the difference those undergone LC and those who did not using unpaired student t-test. After that comparison of LP parameters before surgery, 2 weeks, and 1 month after surgery using paired student t-test to estimate the effect of LC on LP. P < 0.05 considered significant.


  Results Top


Two hundred cases were included in the study. The case group included 93 females and 7 males, whereas the control group included 91 females and 9 males. The mean TC and TG were not different in both baseline and after 2-week readings, but after 1 month, both TC and TG were significantly lower in the case group than the control group.

Mean HDL was higher after both 2 weeks and 1 month in the case group than in the control group. Both LDL and VLDL were not different significantly from the control. [Table 1] shows the distribution of gender and LP parameters between case and control groups.
Table 1: Comparison between case and control groups

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On comparison of the lipid profile of patients undergone surgery, we found that significant reduction in mean TC, TG, and LDL after 1 month of surgery, and a significant increment of mean HDL after 1 month of the surgery, as shown in [Table 2].
Table 2: Comparison of lipid profile before and after surgery of case group

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  Discussion Top


Cholelithiasis and hyperlipidemia are both common disorders with tangled pathophysiology that had cholesterol as a common link. The increased dietary intake of fat had increased the risk of both disorders.[14] In this study, we aimed to investigate the chronological changes in the level of LP parameters after LC.

The study included female participants more than males, this finding may be attributed to the selection technique of only cases of gallstone as GSD is more prevalent in females as found by previous studies.[14]

The LPs of both groups were not different at the starting of the study, this eliminates sampling bias, thus increase the internal validity of the study.

Total cholesterol was found to decrease over time in cases of cholecystectomies, and after 1 month, this difference between the groups became significant. On comparison of the level of TC of the same group over time, we found the decrement was not significant after first 2 weeks but get significant after the 1st month. Sergeev et al.[15] also found a significant decrease in the level of TC after cholecystectomy. Gill and Gupta[16] found a significant decline of TC levels after 1 month and Malik et al.[17] found a significant reduction also for the first 6 months. Osman et al.[18] also stated the reduction in TC started from the 5th day till the 6th month.

Triglycerides level was lower in those undergone LC than in control after 1 month, on running pairwise statistical analysis for comparison of the effect of LC on the same population, we found that significant decline in the level of TG after both 2 weeks and month. Similar results were found by Sergeev et al.,[15] Gill and Gupta,[16] Malik et al.,[17] and Osman et al.[18]

The reduction of both TC and TG may attributed to the fact that removal of the gallbladder is associated with the secretion of more diluted bile leading to increased fecal loss (as stated by Sergeev et al.[15]) of bile which may reduce enterohepatic circulation leading to the altered fat absorption.

The mean HDL was increasing after LC on comparison to the control, on comparison of the measurement before and after LC, we found no significant difference found in the first 2 weeks that became significant after 1 month. A similar result was found by Gill and Gupta,[16] while Malik et al.[17] found that no changes in HDL level on both measurements at 5th day and 6th month of follow-up, this difference in the finding may be attributed to the duration of the follow-up offered for the participants in comparison to the current study. Malik et al.[17] also found no significant difference at the 6th month.

The mean LDL after 1 month of LC was significantly lower than the initial reading, yet this level was not different from the control, thus it may be attributed to other factors other than the surgery. A similar result was found by Gill and Gupta,[16] while Malik et al.[17] also found a significant reduction in the level of LDL after 6 months, and Osman et al.[18] found significant reduction on 2, 4, and 6 months after LC. This reduction of LDL was not compared to the control as done in the current study, and this reduction may be attributed to the duration of the follow-up or other factors that affect the condition other than the surgery.

The mean VLDL was not different from the control, and not changed over time, this result was supported by the result found by other studies (Sergeev et al.,[15] Gill and Gupta,[16] Malik et al.,[17] and Osman et al.[18]).

The limitation of the study was the short period of follow-up, also the effect of diet although advice no change in diet but the exact diet may interfere with the outcome, finally, the effect of body response to trauma may attributed to some of the changes in LP, and this decreased after the use of measurement after 1 month.


  Conclusion Top


LC is associated with a reduction of the serum level of both TC and TG and an increase serum level of HDL after 1 month of follow-up.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Gabash KM, Muzhir HK. The commonest clinical presentation of gallstone disease in laparoscopically cholecystectomized patients. Indian J Forensic Med Toxicol 2021;15:3321.  Back to cited text no. 1
    
2.
Halldestam I, Kullman E, Borch K. Incidence of and potential risk factors for gallstone disease in a general population sample. Br J Surg 2009;96:1315-22.  Back to cited text no. 2
    
3.
Reeves JJ, Broderick RC, Lee AM, Blitzer RR, Waterman RS, Cheverie JN, et al. The price is right: Routine fluorescent cholangiography during laparoscopic cholecystectomy. Surgery 2022;171:1168-76.  Back to cited text no. 3
    
4.
Baiu I, Hawn MT. Gallstones and biliary colic. JAMA 2018;320:1612.  Back to cited text no. 4
    
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Grigor'eva IN. Gallstone disease, obesity and the firmicutes/bacteroidetes ratio as a possible biomarker of gut dysbiosis. J Pers Med 2020;11:13.  Back to cited text no. 5
    
6.
Banach B, Modrzejewski A, Juzyszyn Z, Kurzawski M, Sroczynski T, Pawlik A. Association study of SLCO1B3 and ABCC3 genetic variants in gallstone disease. Genes (Basel) 2022;13:512.  Back to cited text no. 6
    
7.
Hayat S, Hassan Z, Changazi SH, Zahra A, Noman M, Zain Ul Abdin M, et al. Comparative analysis of serum lipid profiles in patients with and without gallstones: A prospective cross-sectional study. Ann Med Surg (Lond) 2019;42:11-3.  Back to cited text no. 7
    
8.
Singh RJ, Kohli K, Gupta AK, Gupt S. Hyperlipidemia: Treatment modality and busting myths of dietary approach. World J Pharm Res SJIF 2018;7:395-406.  Back to cited text no. 8
    
9.
Zhang M, Mao M, Zhang C, Hu F, Cui P, Li G, et al. Blood lipid metabolism and the risk of gallstone disease: A multi-center study and meta-analysis. Lipids Health Dis 2022;21:26.  Back to cited text no. 9
    
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Saldanha P, Suneja P, Raj A. Serum lipid profile in patients with cholesterol containing gallstones: A study from South India. MGM J Med Sci 2020;7:63.  Back to cited text no. 10
  [Full text]  
11.
Cortés VA, Barrera F, Nervi F. Pathophysiological connections between gallstone disease, insulin resistance, and obesity. Obes Rev 2020;21:e12983.  Back to cited text no. 11
    
12.
Yang Y, Zhang J. Bile acid metabolism and circadian rhythms. Am J Physiol Gastrointest Liver Physiol 2020;319:G549-63.  Back to cited text no. 12
    
13.
Qi L, Dai W, Kong J, Tian Y, Chen Y. Cholecystectomy as a risk factor for metabolic dysfunction-associated fatty liver disease: Unveiling the metabolic and chronobiologic clues behind the bile acid enterohepatic circulation. J Physiol Biochem 2021;77:497-510.  Back to cited text no. 13
    
14.
Di Ciaula A, Wang DQ, Portincasa P. An update on the pathogenesis of cholesterol gallstone disease. Curr Opin Gastroenterol 2018;34:71-80.  Back to cited text no. 14
    
15.
Sergeev I, Keren N, Naftali T, Konikoff FM. Cholecystectomy and biliary sphincterotomy increase fecal bile loss and improve lipid profile in dyslipidemia. Dig Dis Sci 2020;65:1223-30.  Back to cited text no. 15
    
16.
Gill GS, Gupta K. Pre- and post-operative comparative analysis of serum lipid profile in patients with cholelithiasis. Int J Appl Basic Med Res 2017;7:186-8.  Back to cited text no. 16
    
17.
Malik AA, Wani ML, Tak SI, Irshad I, Ul-Hassan N. Association of dyslipidaemia with cholilithiasis and effect of cholecystectomy on the same. Int J Surg 2011;9:641-2.  Back to cited text no. 17
    
18.
Osman A, Ibrahim AH, Alzamil AM, Alkhalifa AM, Badghaish DA, Al-Dera FH, et al. Is cholecystectomy in patients with symptomatic uncomplicated cholelithiasis beneficial in improving the lipid profile? Cureus 2020;12:e6729.  Back to cited text no. 18
    



 
 
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