Management of gallstone disease prior to and after metabolic surgery: a single-center observational study

Amanda S Dirnberger; Romano Schneider; Marc Slawik; Katja Linke; Marko Kraljević; Bettina Wölnerhanssen; Ralph Peterli

doi:10.1016/j.soard.2021.10.006

Management of gallstone disease prior to and after metabolic surgery: a single-center observational study

Surg Obes Relat Dis. 2022 Feb;18(2):182-188. doi: 10.1016/j.soard.2021.10.006. Epub 2021 Oct 15.

Authors

Amanda S Dirnberger¹, Romano Schneider¹, Marc Slawik², Katja Linke¹, Marko Kraljević¹, Bettina Wölnerhanssen³, Ralph Peterli⁴

Affiliations

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.
⁴ Department of Visceral Surgery, Clarunis-University Center for Gastrointestinal and Liver Diseases, St. Claraspital and University Hospital Basel, Basel, Switzerland. Electronic address: ralph.peterli@clarunis.ch.

PMID: 34764040
DOI: 10.1016/j.soard.2021.10.006

Abstract

Background: Rapid 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.

Method: Retrospective 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.

Setting: Academic teaching hospital in Switzerland.

Results: After 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.

Conclusion: The 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.

Keywords: Concomitant cholecystectomy; Laparoscopic Roux-en-Y gastric bypass; Laparoscopic sleeve gastrectomy.

Publication types

Observational Study

MeSH terms

Bariatric Surgery* / adverse effects
Bariatric Surgery* / methods
Gallstones* / complications
Gallstones* / surgery
Gastrectomy / methods
Gastric Bypass* / methods
Humans
Laparoscopy* / methods
Obesity, Morbid* / complications
Obesity, Morbid* / surgery
Postoperative Complications / etiology
Retrospective Studies