Management of gallstone disease prior to and after metabolic surgery: a single-center observational study |
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| Institution: | 1. Department of Visceral Surgery, Clarunis–University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, Basel, Switzerland;2. Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Claraspital, Basel, Switzerland;3. St. Clara Research Ltd, St. Claraspital, Basel, Switzerland;1. Department of General Surgery, Cleveland Clinic Florida, Weston, Florida;2. Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida;3. Department of Clinical Research, Cleveland Clinic Florida, Weston, Florida;1. Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut;2. Division of Bariatric, Foregut, and Advanced GI Surgery, Stony Brook Medicine, Stony Brook, New York;3. Department of Surgery, Houston Methodist, Houston, Texas;4. Department of Surgery, Stanford University and Palo Alto VA Health Care Center, Palo Alto, California;1. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri;2. Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, Pennsylvania;3. Bariatric Surgery Program, Temple University Hospital, Philadelphia, Pennsylvania;4. Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania;1. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, Cleveland, Ohio;2. Department of Surgery, Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts;3. Division of General and Bariatric Surgery, Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina;4. Department of Surgery, University of California, Irvine Medical Center, Orange, California;5. Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, Oklahoma;6. Harold Hamm Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma |
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| Abstract: | BackgroundRapid weight loss after bariatric surgery is a risk factor for gallstone formation. There are different strategies regarding its management in bariatric patients, including prophylactic cholecystectomy (CCE) in all patients, concomitant CCE only in symptomatic patients, or concomitant CCE in all patients with known gallstones. We present the safety and long-term results of the last concept.MethodRetrospective single-center analysis of a prospective database on perioperative and long-term results of patients with laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) over a 15-year period. The minimal follow-up was 24 months. Concomitant CCE was intended for all patients with gallstones detected by preoperative sonography.SettingAcademic teaching hospital in Switzerland.ResultsAfter exclusion of patients with a history of CCE (11.5%), a total of 1174 patients (69.6% LRYGB, 30.4% LSG) were included in the final analysis. Preoperative gallbladder pathology was detected in 21.2% of patients, of whom 98.4%, or 20.9% of the total patients, received a concomitant CCE. The additional procedure prolonged the average operation time by 38 minutes (not significant) and did not increase the complication rate compared with bariatric procedure without CCE (3.7% versus 5.7%, P = .26). No complication was directly linked to the CCE. Postoperative symptomatic gallbladder disease was observed in 9.3% of patients (LRYGB 7.0% versus LSG 2.3%, P = .15), with 19.8% of those patients initially presenting with a complication.ConclusionThe concept of concomitant CCE in primary bariatric patients with gallstones was feasible and safe. Nevertheless, 9.3% of primary gallstone-free patients developed postoperative symptomatic gallbladder disease and required subsequent CCE despite routine ursodeoxycholic acid prophylaxis. |
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| Keywords: | Concomitant cholecystectomy Laparoscopic Roux-en-Y gastric bypass Laparoscopic sleeve gastrectomy |
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