ROLE OF CHOLECYSTECTOMY ON POSTOPERATIVE LIPID PROFILE OF PATIENTS UNDERGOING SURGERY

Main Article Content

Osama Jawed Khan
Anam Taj
Sana Ejaz
Nimra Shaikh
Rafia Haleem Shaikh
Muhammad Hammad

Keywords

Lipid Profile, Cholelithiasis, Mean change

Abstract

Introduction: Gallstone disease is an emerging health issue worldwide with its incidence on the rise. The development of gallstone disease is multifactorial, with risk factors including increased age, female sex, obesity, and the use of oral contraceptive pills.


Objective: To determine the mean change (pre and postoperative) in serum lipid profile in patients with cholelithiasis.


Study design: Quasi-Experimental Study.


Setting: This study was conducted at the Department of General Surgery, Dr. Ruth K.M Pfau Civil Hospital, Karachi, Pakistan from September 21, ,2021 to March 20, 2022.


Materials and methods: All patients who fulfilled the inclusion criteria and visited Civil Hospital, Karachi were included in the study. Informed consent was taken after explaining the procedure, risks and benefits of the study. In our study, preoperative 3 ml blood samples after 12 hours fasting were taken from all the patients under aseptic conditions one day before surgery       for assessing the preoperative lipid profile.


Results: The age of the patients ranged from 15 to 65 years with a median of 52.00. In the distribution of gender, 31 (35.2%) were male while 57 (64.8%) were female. Mean ± standard of change in pre and post- operative lipid profile after 1 week, total cholesterol was 4.47±90.98, LDL 5.54±28.82, HDL 2.42±12.87 while triglyceride was 4.18±102.09 and p-value found to be non-significant i.e. (P=0.646), (P=0.075), (P=0.081), (P=0.702) respectively. Mean ± standard of change in pre and post-operative lipid profile after 1 month, total cholesterol was 3.09±88.61, LDL 18.78±42.13, HDL 1.17±12.71 while triglyceride was 10.61±97.91 and non-significant p-value was found in total cholesterol i.e.(P=0.744) HDL (P=0.390), triglyceride (P=0.312) where as p-value was found in LDL (P=0.0001).


Conclusion: It is to be concluded that a highly significant mean change was noted in LDL while insignificant changes were noted in TCL, HDL, and triglyceride in serum lipid profile in patients with cholelithiasis. Further large-scale work is recommended for the validation of current findings.

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References

1. 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(3):186-8.
2. Singh DDP, Sharma DMPC, Mahar DN, Bhat DH, Shahnawaz D. Assessment of serum lipid profile in patients undergoing laparoscopic cholecystectomy. Int J Surg Sci. 2019;3 (3):212-4.
3. Ahi KS, Singh RP, Kaur H, Moudgil A. Serum lipid profile in pre and post cholecystectomy patients. Int J Anatomy Radiol Surg. 2017;6(2):1-6.
4. Haq AMM, Giasuddin ASM. Effect of cholecystectomy on lipid profile in Bangladeshi patients with cholelithiasis. J Metab Syndrome. 2016;05(01).
5. 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(1):e6729.
6. Haq AM, Giasuddin A, Jhuma K, Choudhury M. Effect of cholecystectomy on lipid profile in Bangladeshi patients with cholelithiasis. J Metabolic Synd. 2015;4:192.
7. Faxon DP, Fuster V, Libby P, Beckman JA, Hiatt WR, Thompson RW, et al. Atherosclerotic Vascular Disease Conference: Writing Group III: pathophysiology. Circulation. 2004;109 (21):2617-25.
8. Vodnala D, Rubenfire M, Brook RD. Secondary causes of dyslipidemia. Am J Cardiol. 2012;110(6):823-5.
9. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016;37(39): 2999-3058.
10. Nissen SE, Stroes E, Dent-Acosta RE, Rosenson RS, Lehman SJ, Sattar N, et al. Efficacy and tolerability of evolocumab vs ezetimibe in patients with muscle-related statin intolerance: the GAUSS-3 randomized clinical trial. JAMA. 2016;315(15):1580-90.
11. Vallejo-Vaz AJ, Robertson M, Catapano AL, Watts GF, Kastelein JJ, Packard CJ, et al. Low- density lipoprotein cholesterol lowering for the primary prevention of cardiovascular disease among men with primary elevations of low-density lipoprotein cholesterol levels of 190 mg/dl or above: analyses from the WOSCOPS (West of Scotland Coronary Prevention Study) 5-year randomized trial and 20-year observational follow-up. Circulation. 2017;136(20):1878-91.
12. Ford I, Murray H, McCowan C, Packard CJ. Long-term safety and efficacy of lowering low-density lipoprotein cholesterol with statin therapy: 20-year follow-up of West of Scotland Coronary Prevention Study. Circulation. 2016;133(11):1073-80.
13. Chen X, Yan XR, Zhang LP. Ursodeoxycholic acid after common bile duct stones removal for prevention of recurrence: a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(45):e13086.
14. Ibrahim M, Sarvepalli S, Morris-Stiff G, Rizk M, Bhatt A, Walsh RM, et al. Gallstones: watch and wait, or intervene? Cleve Clin J Med. 2018;85(4):323-31.
15. Kruger AJ, Modi RM, Hinton A, Conwell DL, Krishna SG. Physicians infrequently miss choledocholithiasis prior to cholecystectomy in the United States. Dig Liver Dis. 2018;50 (2):207-8.
16. Parkin E, Stott M, Brockbank J, Galloway S, Welch I, Macdonald A. Patient-reported outcomes for acute gallstone pathology. World J Surg. 2017;41(5):1234-8.
17. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499-502.
18. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Rev Esp Cardiol (Engl Ed). 2017;70(2):115.
19. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082-143.
20. Meeusen JW, Snozek CL, Baumann NA, Jaffe AS, Saenger AK. Reliability of calculated low-density lipoprotein cholesterol. Am J Cardiol. 2015;116(4):538-40.
21. Martin SS, Blaha MJ, Elshazly MB, Toth PP, Kwiterovich PO, Blumenthal RS, et al. Comparison of a novel method vs the Friedewald equation for estimating low-density lipoprotein cholesterol levels from the standard lipid profile. JAMA. 2013;310(19):2061- 8.
22. Herink M, Ito MK. Medication Induced Changes in Lipid and Lipoproteins. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Hershman JM, Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, Morley JE, New M, Purnell J, Sahay R, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext. MDText.com, Inc.; South Dartmouth (MA): May 10, 2018.
23. Gooding HC, Rodday AM, Wong JB, Gillman MW, Lloyd-Jones DM, Leslie LK, et al. Application of pediatric and adult guidelines for treatment of lipid levels among US adolescents transitioning to young adulthood. JAMA Pediatr. 2015;169(6):569-74.