URSODEOXYCHOLIC ACID FOR THE PREVENTION OF CHOLELITHIASIS IN PATIENTS AFTER BARIATRIC SURGERY: A SYSTEMATIC REVIEW

Abstract

Introduction: Bariatric surgery is an effective therapeutic approach for treating severe obesity, resulting in significant weight loss and improvement of various metabolic conditions. However, rapid weight loss following the procedure has been associated with an increased incidence of cholelithiasis—particularly during the early postoperative period—due to heightened bile cholesterol saturation, reduced gallbladder motility, and alterations in enterohepatic circulation. In this context, ursodeoxycholic acid (UDCA) has shown potential to prevent gallstone formation and associated complications, owing to its hydrophilic properties and ability to reduce biliary cholesterol supersaturation. Objective: To evaluate scientific evidence regarding the efficacy of ursodeoxycholic acid in preventing cholelithiasis in patients undergoing bariatric surgery, considering gallstone occurrence, clinical manifestations, and the need for surgical intervention. Methodology: A systematic literature review was conducted in accordance with PRISMA checklist recommendations, covering the stages of study identification, screening, eligibility, and inclusion. The PubMed, SciELO, and Web of Science databases were searched for scientific articles published within the last 10 years. The descriptors used were "ursodeoxycholic acid," "bariatric surgery," "cholelithiasis," "gallstones," and "prophylaxis." Clinical studies, randomized trials, and systematic reviews regarding the prophylactic use of UDCA after bariatric surgery were included. Duplicate studies, publications unrelated to the topic, and papers lacking relevant data on cholelithiasis prevention were excluded. Results: The studies analyzed demonstrated that the prophylactic administration of UDCA was associated with a reduction in gallstone formation following bariatric surgery, in addition to showing a favorable effect on the occurrence of symptomatic cholelithiasis and the need for cholecystectomy. Preventive efficacy varied according to the administered dose, treatment duration, bariatric technique employed, and follow-up period. Conclusion: It was concluded that ursodeoxycholic acid yielded favorable results in preventing cholelithiasis after bariatric surgery, reducing stone formation and its clinical manifestations. Despite the observed benefits, differences among therapeutic protocols indicated a need for greater standardization regarding dosage, duration of intervention, and patient follow-up.