Impact of cholecystectomy on lipid profile levels postoperatively predicting its beneficial effect on dyslipidaemia
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Abstract Background The gallbladder plays a vital role in lipid homeostasis by storing and concentrating bile, which aids in lipid digestion. Gallstones, a common gastrointestinal disorder, are often associated with dyslipidemia and may increase the risk of cardiovascular disease. Cholecystectomy, the surgical removal of the gallbladder, is widely performed, but its impact on lipid metabolism remains under investigation. Aim To evaluate changes in blood lipid levels following cholecystectomy and assess its potential role in improving dyslipidemia and reducing cardiovascular risk. Patients and Methods: This prospective cohort study included 40 patients (aged 22–62 years) undergoing laparoscopic cholecystectomy at Cairo University Hospital from April 2024 to March 2025. Fasting lipid profiles—including LDL, HDL, triglycerides, total cholesterol, and VLDL—were measured preoperatively and at 6 months postoperatively. The Atherogenic Index of Plasma (AIP) and total cholesterol/HDL ratio were used to assess cardiovascular risk. Data were analyzed using SPSS v25 with significance set at p < 0.05. Results Postoperatively, there was a significant reduction in LDL (p = 0.002), free cholesterol (p = 0.003), VLDL (p = 0.031), and HDL risk factor (p = 0.004). HDL and triglyceride levels showed minor reductions that were not statistically significant. Liver enzyme levels ALP, GGT, and TLC also showed significant decreases. Conclusion Cholecystectomy leads to significant reductions in total cholesterol and LDL, suggesting a favorable effect on lipid profiles and potential cardiovascular risk reduction in patients with pre-existing lipid abnormalities. Trial registration not applicable as it’s a prospective cohort study knowing ethical consideration taken we had the approval by Cairo University Ethical committee regulations. Under IRB number MS2132024. Privacy of participants as follows All studyrelated information will be securely held at the general surgery department archive desk. Participants study information will not be released outside the study without the written permission of the participant.
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Impact of cholecystectomy on lipid profile levels postoperatively predicting its beneficial effect on dyslipidaemia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of cholecystectomy on lipid profile levels postoperatively predicting its beneficial effect on dyslipidaemia Mohamed Alatrash, Mohamed Saber Mostafa, George Abdelfady Nashed, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7004667/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The gallbladder plays a vital role in lipid homeostasis by storing and concentrating bile, which aids in lipid digestion. Gallstones, a common gastrointestinal disorder, are often associated with dyslipidemia and may increase the risk of cardiovascular disease. Cholecystectomy, the surgical removal of the gallbladder, is widely performed, but its impact on lipid metabolism remains under investigation. Aim To evaluate changes in blood lipid levels following cholecystectomy and assess its potential role in improving dyslipidemia and reducing cardiovascular risk. Patients and Methods: This prospective cohort study included 40 patients (aged 22–62 years) undergoing laparoscopic cholecystectomy at Cairo University Hospital from April 2024 to March 2025. Fasting lipid profiles—including LDL, HDL, triglycerides, total cholesterol, and VLDL—were measured preoperatively and at 6 months postoperatively. The Atherogenic Index of Plasma (AIP) and total cholesterol/HDL ratio were used to assess cardiovascular risk. Data were analyzed using SPSS v25 with significance set at p < 0.05. Results Postoperatively, there was a significant reduction in LDL (p = 0.002), free cholesterol (p = 0.003), VLDL (p = 0.031), and HDL risk factor (p = 0.004). HDL and triglyceride levels showed minor reductions that were not statistically significant. Liver enzyme levels ALP, GGT, and TLC also showed significant decreases. Conclusion Cholecystectomy leads to significant reductions in total cholesterol and LDL, suggesting a favorable effect on lipid profiles and potential cardiovascular risk reduction in patients with pre-existing lipid abnormalities. Trial registration not applicable as it’s a prospective cohort study knowing ethical consideration taken we had the approval by Cairo University Ethical committee regulations. Under IRB number MS2132024. Privacy of participants as follows All studyrelated information will be securely held at the general surgery department archive desk. Participants study information will not be released outside the study without the written permission of the participant. Cholecystectomy Lipid profile Dyslipidemia Cardiovascular risk Introduction The gallbladder supports the maintenance of lipid homoeostasis of the human body. It plays an essential role in the digestion and absorption of lipid by concentrating and storing hepatic bile. Water is the main component of bile, the initial excretory route for organic compounds such as low water solubility drugs, lipid hormones, and cholesterol ( 1 ). Gallstones are a common gastrointestinal disorder and a leading cause of hospital admissions, associated with substantial health and economic burden. Additionally, recent studies have suggested gallstones may predispose patients to other conditions, such as cardiovascular disease, cancer, and even higher mortality, making it a major health concern worldwide ( 2 ). Cholecystectomy is one of the surgical procedures most frequently performed worldwide. It is generally accepted that gallbladder removal is a benign condition without negatively affecting the normal health status or overall metabolic regulation ( 3 , 4 ). Absorption of cholesterol is chiefly facilitated by the action of bile salts and phospholipids. Excess of cholesterol or insufficiency of bile salts or phospholipids can lead to the nucleation of cholesterol crystals, which can cause gall stones ( 5 , 6 ). Hypothesis is that post-cholecystectomy there is a reduction in the bile acid pool size and an increase in the frequency of entero-hepatic circulation. This can affect the lipid profile levels of patient’s post-cholecystectomy. This study aimed to evaluate levels of blood lipids before and after cholecystectomy. Patients and Methods This prospective cohort study. Conducted on 40 patients aging from 22 years to 62 years admitted to Cairo University Hospital. Data collected from April 2024 to March 2025. Inclusion criteria : The patients were considered appropriate candidates for the present study if they were: Well informed, motivated patient aged from 18 to 65 from both genders with symptoms of gall bladder disease including; recurrent biliary colic, nausea, epigastric pain, Patients must have a proven radiological investigation [pelvi-abdominal ultrasound] showing stones contained in the gall bladder or radiologic signs of wall inflammation, all patients should be able and willing to participate in the study and long term follow up and consented for any possible operative risks and outcomes. Exclusion criteria Patient who were in acute attack of cholecystitis are excluded from the study. Signs include positive murphy’s sign, fever, mass in the right hypochondrial, persistent pain or tenderness in the right hypochondrium more than 48 hours, and leucocytosis, psychologically unstable patients, Pregnancy or lactating patients, Patient on anti dyslipidemic drugs, Patients on restrictive diet or vegetarians and Patients diagnosed with hepatobiliary malignancy. Ethical consideration All procedures in this study fellow Cairo University Ethical committee regulations. Under IRB number MS-213-2024. Privacy of participants as follows: All study-related information will be securely held at the general surgery department archive desk. Participants study information will not be released outside the study without the written permission of the participant. Methods All patients were subjected to the following : Preparation Patients were medically optimized preoperatively for diabetes, hypertension, and cardiac conditions. Measurements of Lipid Profile Fasting blood samples were collected after > 12 hours of fasting. Samples were left to clot at room temperature for 20–30 minutes, centrifuged at 3000 xg for 5 minutes, and then stored at -80°C until analysis. Triglycerides and total cholesterol were measured using enzymatic colorimetric tests, while HDL-C and LDL-C were measured using homogeneous enzymatic colorimetric methods. Lipid levels were interpreted based on the Adult Treatment Panel III (ATP III) guidelines ( 7 ): Fasting Triglycerides : Normal: <150 mg/d and hypertriglyceridemia: 150–499 mg/dL. LDL-C : Normal: <100 mg/d High: ≥100 mg/dL, HDL-C : Low: <40 mg/dL (males), < 50 mg/dL (females) and high: ≥60 mg/dL and total Cholesterol : <200 mg/dL. The Atherogenic Index of Plasma (AIP), based on triglyceride and HDL-C levels, was used to assess and compare the risk of atherosclerotic cardiovascular disease pre- and postoperatively ( 8 ). Additionally, the Total Cholesterol/HDL-C Ratio was used for risk evaluation. Study outcomes The primary outcome was to assess the effect of cholecystectomy on lipid profile levels and Secondary outcomes included evaluating the incidence of abnormal lipid profiles among patients with calculous gallbladder disease and analyzing the correlation between cholecystectomy and its potential benefits in reducing the risk of atherosclerotic cardiovascular disease. Statistical analysis of the data Data were fed to the computer and analyzed using IBM SPSS software package version 25.0. ( Armonk, NY: IBM Corp ). Qualitative data were described using number and percent. The Kolmogorov-Smirnov test was used to verify the normality of distribution Quantitative data were described using range (minimum and maximum), mean, standard deviation, median and interquartile range (IQR). P-values less than 0.05 will be considered as statistically significant. The used tests were : Chi-square test, Paired t-test and Wilcoxon signed ranks test Results Table (1): Basic demographic characteristics of patients. (n=40) No., % Gender Male 10 (25%) Female 30 (75%) Age (mean± SD) 42.1±8.9 (median, IQR) 42.5 (36-48.5) Weight (mean± SD) 81.9±8.7 (median, IQR) 82 (78-87.5) BMI (mean± SD) 30.2±2.9 (median, IQR) 29.9 (28.4-32.1) The majority of study were females (75%), with a mean age of 42.1±8.9 years, a mean weight and BMI of 81.9±8.7 kg and a mean BMI of 30.2±2.9 kg/m 2 respectively. (Table 1) Table (2): Percent and number of individuals of abnormal lipid profile level pre-operatively Abnormal levels No., % Free cholesterol 25 (62.5%) LDL 34 (85%) HDL females HDL males 16/30 (53.3%) 1/10 (10%) Triglycerides 16 (40%) VLDL 11 (27.5%) HDL ratio 16 (40%) Table (3): atherogenic index of plasma per individual Atherogenic index of plasma No., % Low risk 0.21 35 (87.5%) Table (4): Laboratory change post-cholecystectomy Preoperative Postoperative P * Hb (g/dl) (mean± SD) 12.58±1.57 12.81±1.4 0.07 (median, IQR) 12.85 (11.27-13.7) 13.05 (11.9-13.75) AST (U/L) (mean± SD) 49.15±19.46 44.85±16.24 0.269 (median, IQR) 45 (34.75-62) 42 (34-54) ALT (U/L) (mean± SD) 43.8±24.02 43.6±20.6 0.958 (median, IQR) 36 (30-47.5) 36.5 (27-54) Creatinine (mg/dl) (mean± SD) 0.89±0.14 0.92±0.15 0.310 (median, IQR) 0.88 (0.8-1.01) 0.92 (0.82-1.03) ALP (U/L) (mean± SD) 87.8±25.02 73.3±22.9 0.005 (median, IQR) 90 (77.5-100.5) 73.5 (56.25-86.25) GGT (U/L) (mean± SD) 46.35±19.4 38.15±16.9 0.001 (median, IQR) 42 (34-56.5) 35 (25-45) TLC (10⁹/L) (mean± SD) 8.43±1.8 7.4±1.9 0.02 (median, IQR) 8.3 (7.3-9.5) 7.25 (5.7-8.5) INR (mean± SD) 1.09±0.14 1.07±0.11 0.431 (median, IQR) 1.08 (1.0-1.15) 1.03 (0.98-1.1) There were no significant changes in Hb, AST, ALT, creatinine, or INR levels post-cholecystectomy. However, significant reductions were observed in ALP (p=0.005), GGT (p=0.001), and TLC (p=0.02) levels after surgery. (Table 4) Table (5): Lipid profile change post-cholecystectomy Preoperative Postoperative P * HDL (mg/dl) (mean± SD) 46.43±6.6 46.2±6.24 0.515 (median, IQR) 46 (41.75-51) 44.5 (42-52) LDL (mg/dl) (mean± SD) 128.7±34.3 122.9±31.6 0.002 (median, IQR) 132 (109.75-145) 125 (101.75-141.25) Free cholesterol (mg/dl) (mean± SD) 206.03±37.07 194.8±33.7 0.003 (median, IQR) 208.5 (190-230.5) 197.5 (171.75-217.25) Triglycerides (mg/dl) (mean± SD) 132.6±37.2 132.02±37.7 0.381 (median, IQR) 134 (106.75-162) 130.5 (107-164.25) VLDL (mg/dl) (mean± SD) 25.2±7.7 23.6±7.8 0.031 (median, IQR) 27 (19-31) 22.5 (19.5-29) HDL risk factor (mean± SD) 4.6±1.29 4.35±1.17 0.004 (median, IQR) 4.65 (3.6-5.47) 4.37 (3.3-5.26) AIP (mean± SD) 0.45±0.15 0.455±0.15 0.216 (median, IQR) 0.46 (0.34-0.55) 0.46 (0.35-0.57) Post-cholecystectomy, there was a significant decrease in LDL, free cholesterol, VLDL, and HDL risk factor levels p0.05. (Table 5) Table (6): Percent of Abnormal Lipid profile pre and post-cholecystectomy Preoperative Postoperative P * HDL 17 (42.5%) 17 (42.5%) 1.00 LDL 34 (85%) 34 (85%) 1.00 Free cholesterol 25 (62.5%) 19 (47.5%) 0.07 Triglycerides 16 (40%) 15 (37.5%) 1.00 Atherogenic index of plasma Low risk 1 (2.5%) 1 (2.5%) 0.317 Intermediate risk 4 (10%) 3 (7.5%) Increased risk 35 (87.5%) 36 (90%) HDL ratio 16 (40%) 13 (32.5) 0.09 *: Mc nemar test. Percent of patients with abnormal elevated serum cholesterol and triglycerides level showed postoperative reduction, yet, insignificant p>0.05. (Table 6) Discussion The majority of study population were females (75%), with a mean age of 42.1 ± 8.9 years with the mean weight of study sample was 81.9 ± 8.7 kg and BMI of 30.2 ± 2.9 kg/m2. In coherence with our study, Altan Aydin, et al. ( 9 ) had eighty patients participated in the study, the mean age was 49 ± 13, sixty (75%) patients were female. In a study done by Karki, OB. et al. ( 10 ) of the 73 patients with cholelithiasis, 66% were female and 34% male, the mean age of patients was 40.53 ± 13.16 years. Both studies had similar age groups in coherence to our study. In our study the conversion rate from laparoscopy to open was nil and hospital stay was 1.8 ± 0.4 days. In Altan et al ( 9 ) the average hospital stay was 2.1 ± 0.3 days. In our study seven out of 30 female patients reported the use of contraceptive pills. In coherence of our study, F Kern, et al. ( 11 ) Contraceptive steroids increase the risk of acquiring cholesterol gallstones. This is due to increase in cholesterol saturation of bile. In a cross sectional studies done by Sethulakshmi, S. et al. ( 12 ) the prevalence of dyslipidaemia among gall stone patients estimated was 51.2%. In our study, the levels of lipid profile were spotted pre-operatively, and we found that 62.5% of patients had abnormal free cholesterol, 85% of patients had abnormal LDL level, and 42.5% of patients had abnormal HDL. Postoperative duration of follow-up for lipid profile levels differed along with many studies. Altan, et al. ( 9 ) measured lipid profile levels 8 weeks postoperatively while Karki, OB. et al. ( 10 ) had postoperative follow-up after 1 week and 1 month. Our study had measurement after 6 months’ follow-up period. In coherence to Ajaz Malik et al. ( 13 ) who measured lipid profile levels 6 months postoperatively. Postoperative levels of lipid profile was measured and showed the following: a significant postoperative decrease in; LDL (p value = 0.002), Free cholesterol (p value = 0.003), VLDL (p value = 0.031) and HDL risk factor (p value = 0.004), also, a postoperative reduction of HDL and triglycerides was noticed, yet, insignificant reduction. Gill et al. ( 14 ) showed a decreased serum lipid levels of the postoperative group (1 month after surgery) with a decrease in mean levels of serum cholesterol and TGs which was significant after 1 month of surgery. The serum HDLC slightly increased after 1 month of surgery, however, no significant difference was observed in LDLC and VLDLC after 1 month of surgery. Moreover, Altan, et al. ( 9 ) demonstrated that cholecystectomy caused a significant reduction of LDL and total cholesterol levels. Furthermore, the results of this study showed that cholecystectomy did not affect triglyceride and HDL-C levels. Serum concentrations of free cholesterol, TG and HDL-c levels were significantly reduced in patients after cholecystectomy at one-month interval in Karki et al. ( 10 ). Similar findings have been noticed in other studies like Ajaz Malik et al. ( 13 ). In our study, artherogenic index of plasma was calculated pre and postoperatively, the change was not significant as a consequence of non-significant change of triglycerides and HDL-c levels postoperatively. Current data suggest that 40 mg/dl decrease in LDL levels can be translated to 10% decrease in all-cause mortality, 24% reduction in major coronary events and 15% in stroke ( 15 ). In our study the mean reduction in LDL was 9 mg/dl. With a p value = 0.002. Hypothesis states that after cholecystectomy, a reduced level of bile acid pool size coupled with increases in entero-hepatic circulation frequency tends to lower lipid levels by causing a reduction in the total cholesterol level as well as low density lipoprotein (LDL) cholesterol levels as well ( 16 ). Conclusion Cholecystectomy significantly reduces total cholesterol and LDL levels, with no notable impact on triglycerides or HDL. It may help improve lipid profiles and lower cardiovascular risk in patients with pre-existing lipid abnormalities. Declarations Data availability statement: The data that support all of these findings are available upon request from the corresponding author MohamedAlatrash, contactable by email. Conflicts of interest: no conflict of interest. Funding statement: the research was conducted with no external funding. Author Contributions: Mohamed Alatrash: Conceptualization, data collection, statistical analysis manuscript writing. Mohamed Saber Mostafa: Data analysis, manuscript revision. George Abdelfady Nashed: Data acquisition and interpretation. George Mosaad: Literature review and statistical analysis. Mahmoud Dewair: Supervision, critical revision of the manuscript for important intellectual content Consent to publish declarations: not applicable References Browning MG, Pessoa BM, Khoraki J, Campos GM. Changes in Bile Acid Metabolism, Transport, and Signaling as Central Drivers for Metabolic Improvements after Bariatric Surgery. Curr Obes Rep. 2019;8(2):175–84. Wang X, Yu W, Jiang G, Li H, Li S, Xie L, Bai X, Cui P, Chen Q, Lou Y, Zou L. Global epidemiology of gallstones in the 21st century: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2024 Feb 19. Qi L, Tian Y, Chen Y. Gall bladder: The metabolic orchestrator. Diab/Metab Res Rev. 2019;35(5):e3140. Di Ciaula A, Garruti G, Wang DQ, Portincasa P. Cholecystectomy and risk of metabolic syndrome. Eur J Intern Med. 2018;53:3–11. Dowais R, Al Sharie S, Araydah M, Al Khasawneh S, Haddad F, AlJaiuossi A. Pearl-white gallstones: A report of a case and a chemical analysis by FTIR and XRD. Int J Surg Case Rep. 2021;87:106449. Wang HH, Portincasa P, Liu M, Wang DQ. Effects of biliary phospholipids on cholesterol crystallization and growth in gallstone formation. Adv Therapy. 2023;40(3):743–68. Lipsy RJ. The national cholesterol education program adult treatment panel III guidelines. J managed care pharmacy: JMCP. 2003;9(1 Suppl):2–5. Quispe R, Elshazly MB, Zhao D, Toth PP, Puri R, Virani SS, Blumenthal RS, Martin SS, Jones SR, Michos ED. Total cholesterol/HDL-cholesterol ratio discordance with LDL-cholesterol and non-HDL-cholesterol and incidence of atherosclerotic cardiovascular disease in primary prevention: The ARIC study. Eur J Prev Cardiol. 2020;27(15):1597–605. Altan AYDIN, Doğan ÖZTÜRK. Effects of cholecystectomy on lipid profile. J Experimental Clin Med. 2022;39(4):1246–8. Karki OB, Timilsina BD. Effect of Cholecystectomy on Serum Lipids and Blood Glucose (Hospital Based Observational Prospective Study). Nepal J Med Sci. 2021;6(1):8–13. Kern F, Everson GT. Contraceptive steroids increase cholesterol in bile: mechanisms of action. J Lipid Res. 1987;28(7):828–39. sethulakshmi S, vineed S. Serbin mohammed. A Cross-sectional Study to Estimate the Prevalence of Dyslipidaemia in Patients with Cholelithiasis. Int J Anat Radiol Surg 2021 Oct, Vol-10(4): SO05–7. 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(8):641–2. Gill GS, Gupta K. Pre- and Post-operative comparative analysis of serum lipid profile in patients with cholelithiasis. Int J App Basic Med Res. 2017;7:186–8. Soran H, Dent R, Dirrington P. Evidence-based goals in LDLC reduction. Clin Res Cardiol. 2017;106:237–48. Singh DP. Assessment of serum lipid profile in patients undergoing laparoscopic cholecystectomy. Int J Surg. 2019;3(3):212–4. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7004667","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":491530708,"identity":"6b6c0d67-d9e1-4b57-8c92-7e7dded47a69","order_by":0,"name":"Mohamed Alatrash","email":"data:image/png;base64,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","orcid":"","institution":"Cairo University","correspondingAuthor":true,"prefix":"","firstName":"Mohamed","middleName":"","lastName":"Alatrash","suffix":""},{"id":491530709,"identity":"134996fc-341a-4351-aa55-446387e83d26","order_by":1,"name":"Mohamed Saber Mostafa","email":"","orcid":"","institution":"Cairo University","correspondingAuthor":false,"prefix":"","firstName":"Mohamed","middleName":"Saber","lastName":"Mostafa","suffix":""},{"id":491530710,"identity":"80ecd28d-a005-49f8-8ae4-fba5b7257072","order_by":2,"name":"George Abdelfady Nashed","email":"","orcid":"","institution":"Cairo University","correspondingAuthor":false,"prefix":"","firstName":"George","middleName":"Abdelfady","lastName":"Nashed","suffix":""},{"id":491530711,"identity":"740a1fbc-d2de-4ad5-91dc-3227e0bf5301","order_by":3,"name":"George Mosaad","email":"","orcid":"","institution":"Cairo University","correspondingAuthor":false,"prefix":"","firstName":"George","middleName":"","lastName":"Mosaad","suffix":""},{"id":491530712,"identity":"67c8180c-d642-449c-a0ed-0ed1017b7e05","order_by":4,"name":"Mahmoud Dewair","email":"","orcid":"","institution":"Cairo University","correspondingAuthor":false,"prefix":"","firstName":"Mahmoud","middleName":"","lastName":"Dewair","suffix":""}],"badges":[],"createdAt":"2025-06-29 20:08:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7004667/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7004667/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87923647,"identity":"3a93f743-18f8-4ef7-b588-bd3d1c7d3c34","added_by":"auto","created_at":"2025-07-30 12:09:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1614726,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7004667/v1/63f0d69b-640b-4bf3-a822-732ac3c16a0e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of cholecystectomy on lipid profile levels postoperatively predicting its beneficial effect on dyslipidaemia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe gallbladder supports the maintenance of lipid homoeostasis of the human body. It plays an essential role in the digestion and absorption of lipid by concentrating and storing hepatic bile. Water is the main component of bile, the initial excretory route for organic compounds such as low water solubility drugs, lipid hormones, and cholesterol (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGallstones are a common gastrointestinal disorder and a leading cause of hospital admissions, associated with substantial health and economic burden. Additionally, recent studies have suggested gallstones may predispose patients to other conditions, such as cardiovascular disease, cancer, and even higher mortality, making it a major health concern worldwide (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCholecystectomy is one of the surgical procedures most frequently performed worldwide. It is generally accepted that gallbladder removal is a benign condition without negatively affecting the normal health status or overall metabolic regulation (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAbsorption of cholesterol is chiefly facilitated by the action of bile salts and phospholipids. Excess of cholesterol or insufficiency of bile salts or phospholipids can lead to the nucleation of cholesterol crystals, which can cause gall stones (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHypothesis is that post-cholecystectomy there is a reduction in the bile acid pool size and an increase in the frequency of entero-hepatic circulation. This can affect the lipid profile levels of patient\u0026rsquo;s post-cholecystectomy.\u003c/p\u003e\u003cp\u003eThis study aimed to evaluate levels of blood lipids before and after cholecystectomy.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003eThis prospective cohort study. Conducted on 40 patients aging from 22 years to 62 years admitted to Cairo University Hospital. Data collected from April 2024 to March 2025.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion criteria\u003c/b\u003e: The patients were considered appropriate candidates for the present study if they were: Well informed, motivated patient aged from 18 to 65 from both genders with symptoms of gall bladder disease including; recurrent biliary colic, nausea, epigastric pain, Patients must have a proven radiological investigation [pelvi-abdominal ultrasound] showing stones contained in the gall bladder or radiologic signs of wall inflammation, all patients should be able and willing to participate in the study and long term follow up and consented for any possible operative risks and outcomes.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003cp\u003ePatient who were in acute attack of cholecystitis are excluded from the study. Signs include positive murphy\u0026rsquo;s sign, fever, mass in the right hypochondrial, persistent pain or tenderness in the right hypochondrium more than 48 hours, and leucocytosis, psychologically unstable patients, Pregnancy or lactating patients, Patient on anti dyslipidemic drugs, Patients on restrictive diet or vegetarians and Patients diagnosed with hepatobiliary malignancy.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical consideration\u003c/b\u003e\u003c/p\u003e\u003cp\u003e All procedures in this study fellow Cairo University Ethical committee regulations. Under IRB number MS-213-2024. Privacy of participants as follows: All study-related information will be securely held at the general surgery department archive desk. Participants study information will not be released outside the study without the written permission of the participant.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAll patients were subjected to the following\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cb\u003ePreparation\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatients were medically optimized preoperatively for diabetes, hypertension, and cardiac conditions.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMeasurements of Lipid Profile\u003c/strong\u003e\u003cp\u003eFasting blood samples were collected after \u0026gt;\u0026thinsp;12 hours of fasting. Samples were left to clot at room temperature for 20\u0026ndash;30 minutes, centrifuged at 3000 xg for 5 minutes, and then stored at -80\u0026deg;C until analysis.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eTriglycerides and total cholesterol were measured using enzymatic colorimetric tests, while HDL-C and LDL-C were measured using homogeneous enzymatic colorimetric methods.\u003c/p\u003e\u003cp\u003eLipid levels were interpreted based on the Adult Treatment Panel III (ATP III) guidelines (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e): \u003cb\u003eFasting Triglycerides\u003c/b\u003e: Normal: \u0026lt;150 mg/d and hypertriglyceridemia: 150\u0026ndash;499 mg/dL. \u003cb\u003eLDL-C\u003c/b\u003e: Normal: \u0026lt;100 mg/d High: \u0026ge;100 mg/dL, \u003cb\u003eHDL-C\u003c/b\u003e: Low: \u0026lt;40 mg/dL (males), \u0026lt;\u0026thinsp;50 mg/dL (females) and high: \u0026ge;60 mg/dL and \u003cb\u003etotal Cholesterol\u003c/b\u003e: \u0026lt;200 mg/dL. The \u003cb\u003eAtherogenic Index of Plasma\u003c/b\u003e (AIP), based on triglyceride and HDL-C levels, was used to assess and compare the risk of atherosclerotic cardiovascular disease pre- and postoperatively (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Additionally, the Total Cholesterol/HDL-C Ratio was used for risk evaluation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStudy outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe primary outcome was to assess the effect of cholecystectomy on lipid profile levels and Secondary outcomes included evaluating the incidence of abnormal lipid profiles among patients with calculous gallbladder disease and analyzing the correlation between cholecystectomy and its potential benefits in reducing the risk of atherosclerotic cardiovascular disease.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistical analysis of the data\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData were fed to the computer and analyzed using IBM SPSS software package version 25.0. \u003cb\u003e(\u003c/b\u003eArmonk, NY: IBM Corp\u003cb\u003e).\u003c/b\u003e Qualitative data were described using number and percent. The Kolmogorov-Smirnov test was used to verify the normality of distribution Quantitative data were described using range (minimum and maximum), mean, standard deviation, median and interquartile range (IQR). P-values less than 0.05 will be considered as statistically significant. \u003cb\u003eThe used tests were\u003c/b\u003e: Chi-square test, Paired t-test and Wilcoxon signed ranks test\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eTable (1): Basic demographic characteristics of patients. (n=40)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo., %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e10 (25%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e30 (75%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e42.1\u0026plusmn;8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e(median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e42.5 (36-48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e81.9\u0026plusmn;8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e(median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e82 (78-87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e30.2\u0026plusmn;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e(median, IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e29.9 (28.4-32.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe majority of study were females (75%), with a mean age of 42.1\u0026plusmn;8.9 years, a mean weight and BMI of 81.9\u0026plusmn;8.7 kg and a mean BMI of 30.2\u0026plusmn;2.9 kg/m\u003csup\u003e2\u003c/sup\u003e respectively. (Table 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (2): Percent and number of individuals of abnormal lipid profile level pre-operatively\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 308px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbnormal levels\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo., %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 308px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFree cholesterol\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e25 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 308px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLDL\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e34 (85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 308px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHDL females\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHDL males\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e16/30 (53.3%)\u003c/p\u003e\n \u003cp\u003e1/10 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 308px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTriglycerides\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e16 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 308px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVLDL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e11 (27.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 308px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHDL ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e16 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable (3): atherogenic index of plasma per individual\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 308px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAtherogenic index of plasma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo., %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 308px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow risk \u0026lt;0.11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (2.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 308px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntermediate risk 0.11 to 0.21\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 (10%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 308px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh risk \u0026gt;0.21\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 323px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e35 (87.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable (4): Laboratory change post-cholecystectomy\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHb (g/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12.58\u0026plusmn;1.57\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12.81\u0026plusmn;1.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.07\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12.85 (11.27-13.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13.05 (11.9-13.75)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAST (U/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e49.15\u0026plusmn;19.46\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e44.85\u0026plusmn;16.24\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.269\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e45 (34.75-62)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e42 (34-54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eALT (U/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e43.8\u0026plusmn;24.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e43.6\u0026plusmn;20.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.958\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e36 (30-47.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e36.5 (27-54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCreatinine (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.89\u0026plusmn;0.14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.92\u0026plusmn;0.15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.310\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.88 (0.8-1.01)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.92 (0.82-1.03)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eALP (U/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e87.8\u0026plusmn;25.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e73.3\u0026plusmn;22.9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e90 (77.5-100.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e73.5 (56.25-86.25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGGT (U/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46.35\u0026plusmn;19.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e38.15\u0026plusmn;16.9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e42 (34-56.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e35 (25-45)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTLC (10⁹/L)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.43\u0026plusmn;1.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.4\u0026plusmn;1.9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.3 (7.3-9.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.25 (5.7-8.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eINR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.09\u0026plusmn;0.14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.07\u0026plusmn;0.11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.431\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.08 (1.0-1.15)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.03 (0.98-1.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThere were no significant changes in Hb, AST, ALT, creatinine, or INR levels post-cholecystectomy. However, significant reductions were observed in ALP (p=0.005), GGT (p=0.001), and TLC (p=0.02) levels after surgery. (Table 4)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (5): Lipid profile change post-cholecystectomy\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHDL (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46.43\u0026plusmn;6.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46.2\u0026plusmn;6.24\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.515\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46 (41.75-51)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e44.5 (42-52)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLDL (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e128.7\u0026plusmn;34.3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e122.9\u0026plusmn;31.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e132 (109.75-145)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e125 (101.75-141.25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFree cholesterol (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e206.03\u0026plusmn;37.07\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e194.8\u0026plusmn;33.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e208.5 (190-230.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e197.5 (171.75-217.25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTriglycerides (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e132.6\u0026plusmn;37.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e132.02\u0026plusmn;37.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.381\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e134 (106.75-162)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e130.5 (107-164.25)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVLDL (mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25.2\u0026plusmn;7.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23.6\u0026plusmn;7.8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27 (19-31)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e22.5 (19.5-29)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHDL risk factor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.6\u0026plusmn;1.29\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.35\u0026plusmn;1.17\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.65 (3.6-5.47)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.37 (3.3-5.26)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 623px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAIP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(mean\u0026plusmn; SD)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.45\u0026plusmn;0.15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.455\u0026plusmn;0.15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.216\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(median, IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.46 (0.34-0.55)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.46 (0.35-0.57)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePost-cholecystectomy, there was a significant decrease in LDL, free cholesterol, VLDL, and HDL risk factor levels p\u0026lt;0.05. Reductions in HDL and triglycerides were observed but were not statistically significant p\u0026gt;0.05. (Table 5)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (6): Percent of Abnormal Lipid profile pre and post-cholecystectomy\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP *\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHDL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17 (42.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e17 (42.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLDL\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e34 (85%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e34 (85%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFree cholesterol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25 (62.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e19 (47.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.07\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTriglycerides\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16 (40%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15 (37.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.00\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 624px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAtherogenic index of plasma\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLow risk\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (2.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 (2.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.317\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntermediate risk\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 (10%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 (7.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncreased risk\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e35 (87.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e36 (90%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHDL ratio\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16 (40%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 182px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13 (32.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.09\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp; *: Mc nemar test.\u003c/p\u003e\n\u003cp\u003ePercent of patients with abnormal elevated serum cholesterol and triglycerides level showed postoperative reduction, yet, insignificant p\u0026gt;0.05. (Table 6)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe majority of study population were females (75%), with a mean age of 42.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9 years with the mean weight of study sample was 81.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7 kg and BMI of 30.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 kg/m2. In coherence with our study, \u003cb\u003eAltan Aydin, et al.\u003c/b\u003e (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) had eighty patients participated in the study, the mean age was 49\u0026thinsp;\u0026plusmn;\u0026thinsp;13, sixty (75%) patients were female. In a study done by \u003cb\u003eKarki, OB. et al.\u003c/b\u003e (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) of the 73 patients with cholelithiasis, 66% were female and 34% male, the mean age of patients was 40.53\u0026thinsp;\u0026plusmn;\u0026thinsp;13.16 years. Both studies had similar age groups in coherence to our study.\u003c/p\u003e\u003cp\u003eIn our study the conversion rate from laparoscopy to open was nil and hospital stay was 1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 days. In \u003cb\u003eAltan et al\u003c/b\u003e (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) the average hospital stay was 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3 days.\u003c/p\u003e\u003cp\u003eIn our study seven out of 30 female patients reported the use of contraceptive pills. In coherence of our study, \u003cb\u003eF Kern, et al.\u003c/b\u003e (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Contraceptive steroids increase the risk of acquiring cholesterol gallstones. This is due to increase in cholesterol saturation of bile.\u003c/p\u003e\u003cp\u003eIn a cross sectional studies done by \u003cb\u003eSethulakshmi, S. et al.\u003c/b\u003e (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) the prevalence of dyslipidaemia among gall stone patients estimated was 51.2%. In our study, the levels of lipid profile were spotted pre-operatively, and we found that 62.5% of patients had abnormal free cholesterol, 85% of patients had abnormal LDL level, and 42.5% of patients had abnormal HDL.\u003c/p\u003e\u003cp\u003ePostoperative duration of follow-up for lipid profile levels differed along with many studies. \u003cb\u003eAltan, et al.\u003c/b\u003e (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) measured lipid profile levels 8 weeks postoperatively while \u003cb\u003eKarki, OB. et al.\u003c/b\u003e (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) had postoperative follow-up after 1 week and 1 month. Our study had measurement after 6 months\u0026rsquo; follow-up period. In coherence to \u003cb\u003eAjaz Malik et al.\u003c/b\u003e (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) who measured lipid profile levels 6 months postoperatively.\u003c/p\u003e\u003cp\u003ePostoperative levels of lipid profile was measured and showed the following: a significant postoperative decrease in; LDL (p value\u0026thinsp;=\u0026thinsp;0.002), Free cholesterol (p value\u0026thinsp;=\u0026thinsp;0.003), VLDL (p value\u0026thinsp;=\u0026thinsp;0.031) and HDL risk factor (p value\u0026thinsp;=\u0026thinsp;0.004), also, a postoperative reduction of HDL and triglycerides was noticed, yet, insignificant reduction.\u003c/p\u003e\u003cp\u003e\u003cb\u003eGill et al.\u003c/b\u003e (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) showed a decreased serum lipid levels of the postoperative group (1 month after surgery) with a decrease in mean levels of serum cholesterol and TGs which was significant after 1 month of surgery. The serum HDLC slightly increased after 1 month of surgery, however, no significant difference was observed in LDLC and VLDLC after 1 month of surgery.\u003c/p\u003e\u003cp\u003eMoreover, \u003cb\u003eAltan, et al.\u003c/b\u003e (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) demonstrated that cholecystectomy caused a significant reduction of LDL and total cholesterol levels. Furthermore, the results of this study showed that cholecystectomy did not affect triglyceride and HDL-C levels.\u003c/p\u003e\u003cp\u003eSerum concentrations of free cholesterol, TG and HDL-c levels were significantly reduced in patients after cholecystectomy at one-month interval in \u003cb\u003eKarki et al.\u003c/b\u003e (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Similar findings have been noticed in other studies like \u003cb\u003eAjaz Malik et al.\u003c/b\u003e (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn our study, artherogenic index of plasma was calculated pre and postoperatively, the change was not significant as a consequence of non-significant change of triglycerides and HDL-c levels postoperatively.\u003c/p\u003e\u003cp\u003eCurrent data suggest that 40 mg/dl decrease in LDL levels can be translated to 10% decrease in all-cause mortality, 24% reduction in major coronary events and 15% in stroke (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In our study the mean reduction in LDL was 9 mg/dl. With a p value\u0026thinsp;=\u0026thinsp;0.002.\u003c/p\u003e\u003cp\u003eHypothesis states that after cholecystectomy, a reduced level of bile acid pool size coupled with increases in entero-hepatic circulation frequency tends to lower lipid levels by causing a reduction in the total cholesterol level as well as low density lipoprotein (LDL) cholesterol levels as well (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCholecystectomy significantly reduces total cholesterol and LDL levels, with no notable impact on triglycerides or HDL. It may help improve lipid profiles and lower cardiovascular risk in patients with pre-existing lipid abnormalities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support all of these findings are available upon request from the corresponding author MohamedAlatrash, contactable by email.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e\u0026nbsp; \u0026nbsp;no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding statement:\u0026nbsp;\u003c/strong\u003ethe research was conducted with no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMohamed Alatrash: Conceptualization, data collection, statistical analysis manuscript writing.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Mohamed Saber Mostafa: Data analysis, manuscript revision.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGeorge Abdelfady Nashed: Data acquisition and interpretation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGeorge Mosaad: Literature review and statistical analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMahmoud Dewair: Supervision, critical revision of the manuscript for important intellectual content\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish declarations:\u0026nbsp;\u003c/strong\u003enot applicable\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBrowning MG, Pessoa BM, Khoraki J, Campos GM. Changes in Bile Acid Metabolism, Transport, and Signaling as Central Drivers for Metabolic Improvements after Bariatric Surgery. Curr Obes Rep. 2019;8(2):175\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang X, Yu W, Jiang G, Li H, Li S, Xie L, Bai X, Cui P, Chen Q, Lou Y, Zou L. Global epidemiology of gallstones in the 21st century: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2024 Feb 19.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQi L, Tian Y, Chen Y. Gall bladder: The metabolic orchestrator. Diab/Metab Res Rev. 2019;35(5):e3140.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDi Ciaula A, Garruti G, Wang DQ, Portincasa P. Cholecystectomy and risk of metabolic syndrome. Eur J Intern Med. 2018;53:3\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDowais R, Al Sharie S, Araydah M, Al Khasawneh S, Haddad F, AlJaiuossi A. Pearl-white gallstones: A report of a case and a chemical analysis by FTIR and XRD. Int J Surg Case Rep. 2021;87:106449.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang HH, Portincasa P, Liu M, Wang DQ. Effects of biliary phospholipids on cholesterol crystallization and growth in gallstone formation. Adv Therapy. 2023;40(3):743\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLipsy RJ. The national cholesterol education program adult treatment panel III guidelines. J managed care pharmacy: JMCP. 2003;9(1 Suppl):2\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQuispe R, Elshazly MB, Zhao D, Toth PP, Puri R, Virani SS, Blumenthal RS, Martin SS, Jones SR, Michos ED. Total cholesterol/HDL-cholesterol ratio discordance with LDL-cholesterol and non-HDL-cholesterol and incidence of atherosclerotic cardiovascular disease in primary prevention: The ARIC study. Eur J Prev Cardiol. 2020;27(15):1597\u0026ndash;605.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAltan AYDIN, Doğan \u0026Ouml;ZT\u0026Uuml;RK. Effects of cholecystectomy on lipid profile. J Experimental Clin Med. 2022;39(4):1246\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarki OB, Timilsina BD. Effect of Cholecystectomy on Serum Lipids and Blood Glucose (Hospital Based Observational Prospective Study). Nepal J Med Sci. 2021;6(1):8\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKern F, Everson GT. Contraceptive steroids increase cholesterol in bile: mechanisms of action. J Lipid Res. 1987;28(7):828\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003esethulakshmi S, vineed S. Serbin mohammed. A Cross-sectional Study to Estimate the Prevalence of Dyslipidaemia in Patients with Cholelithiasis. Int J Anat Radiol Surg 2021 Oct, Vol-10(4): SO05\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMalik 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(8):641\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGill GS, Gupta K. Pre- and Post-operative comparative analysis of serum lipid profile in patients with cholelithiasis. Int J App Basic Med Res. 2017;7:186\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSoran H, Dent R, Dirrington P. Evidence-based goals in LDLC reduction. Clin Res Cardiol. 2017;106:237\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh DP. Assessment of serum lipid profile in patients undergoing laparoscopic cholecystectomy. Int J Surg. 2019;3(3):212\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cholecystectomy, Lipid profile, Dyslipidemia, Cardiovascular risk","lastPublishedDoi":"10.21203/rs.3.rs-7004667/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7004667/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eThe gallbladder plays a vital role in lipid homeostasis by storing and concentrating bile, which aids in lipid digestion. Gallstones, a common gastrointestinal disorder, are often associated with dyslipidemia and may increase the risk of cardiovascular disease. Cholecystectomy, the surgical removal of the gallbladder, is widely performed, but its impact on lipid metabolism remains under investigation.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e\u003cp\u003eTo evaluate changes in blood lipid levels following cholecystectomy and assess its potential role in improving dyslipidemia and reducing cardiovascular risk.\u003c/p\u003e\u003ch2\u003ePatients and Methods:\u003c/h2\u003e\u003cp\u003eThis prospective cohort study included 40 patients (aged 22\u0026ndash;62 years) undergoing laparoscopic cholecystectomy at Cairo University Hospital from April 2024 to March 2025. Fasting lipid profiles\u0026mdash;including LDL, HDL, triglycerides, total cholesterol, and VLDL\u0026mdash;were measured preoperatively and at 6 months postoperatively. The Atherogenic Index of Plasma (AIP) and total cholesterol/HDL ratio were used to assess cardiovascular risk. Data were analyzed using SPSS v25 with significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003ePostoperatively, there was a significant reduction in LDL (p\u0026thinsp;=\u0026thinsp;0.002), free cholesterol (p\u0026thinsp;=\u0026thinsp;0.003), VLDL (p\u0026thinsp;=\u0026thinsp;0.031), and HDL risk factor (p\u0026thinsp;=\u0026thinsp;0.004). HDL and triglyceride levels showed minor reductions that were not statistically significant. Liver enzyme levels ALP, GGT, and TLC also showed significant decreases.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eCholecystectomy leads to significant reductions in total cholesterol and LDL, suggesting a favorable effect on lipid profiles and potential cardiovascular risk reduction in patients with pre-existing lipid abnormalities.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e\u003cp\u003enot applicable as it\u0026rsquo;s a prospective cohort study knowing ethical consideration taken we had the approval by Cairo University Ethical committee regulations. Under IRB number MS2132024. Privacy of participants as follows All studyrelated information will be securely held at the general surgery department archive desk. Participants study information will not be released outside the study without the written permission of the participant.\u003c/p\u003e","manuscriptTitle":"Impact of cholecystectomy on lipid profile levels postoperatively predicting its beneficial effect on dyslipidaemia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-28 17:41:28","doi":"10.21203/rs.3.rs-7004667/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8598fd1f-e457-418f-bc0f-2ac87d598914","owner":[],"postedDate":"July 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-30T12:09:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-28 17:41:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7004667","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7004667","identity":"rs-7004667","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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