Are Concomitant Operations During Bariatric Surgery Safe? An Analysis of the MBSAQIP Database

Clapp, Benjamin; Lee, Isaac; Liggett, Evan; Cutshall, Michael; Tudor, Bryson; Pradhan, Grishma; Aguirre, Katherine; Tyroch, Alan

doi:10.1007/s11695-020-04848-y

Cited by 16 publications

(7 citation statements)

References 21 publications

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“…Xia et al 13 and Amorini-Cruz et al 17 did not confirm this finding through in-depth meta-analyses, and neither do we repeat this finding, which has had an influence on several guidelines, including those of the ASMBS. 11 Clapp et al 18 observed an increase in length of stay, re-hospitalizations, and reoperations when SG was associated with cholecystectomy. Dakour Aridi et al 19 studied the impact of concurrent cholecystectomy too, from the NSQIP database, analyzing 21,137 patients who had a SG.…”

Section: Discussionmentioning

confidence: 99%

“…These results prompt us to refrain from recommending a systematic cholecystectomy as the risk of severe complications was low within the first 18 months and similar to the preoperative thereafter as suggested by Wanjura and colleagues. In the same way, the likelihood of having a cholecystectomy increases further when dieting-induced weight reduction occurs within the context of a rigorous nutritional follow-up 2,18 ; nevertheless, in this circumstances, there is no guidelines recommending CC. Finally, given that we have shown a dramatic decline in the use of CC in SG and GBP since 2013, with respective rates of 1.8% and 3.5% in 2021, we believe that most bariatric surgeons are adhering to this advice.…”

Section: Table 2 Ninety-day Complication Rates In the Matched Cohorts...mentioning

confidence: 99%

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Risk-Benefit Balance of Simultaneous Gastric Bypass or Sleeve Gastrectomy and Concomitant Cholecystectomy

Marciniak

Lenne²,

Bruandet³

et al. 2023

Annals of Surgery

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Objective: To assess the relevance of concomitant laparoscopic metabolic bariatric surgery (MBS) and cholecystectomy. Summary background data: Because of the massive weight loss it induces, MBS is associated with an increase in the frequency of gallstones. However, no consensus yet exists on the risk-to-benefit ratio of a concomitant cholecystectomy (CC) during MBS to prevent long-term biliary complications. Methods: This nationwide retrospective cohort research was conducted in two parts using information from a national administrative database (PMSI). The 90-day morbidity of MBS with or without CC was first compared in a matched trial (propensity score). Second, we observed medium-term biliary complication following MBS when no CChad been performed during MBS up to 9 years after MBS (minimum 18 mo) Results: Between 2013 and 2020, 289,627 patients had a sleeve gastrectomy (SG: 70%) or a gastric bypass (GBP: 30%). The principal indications of CC were symptomatic cholelithiasis (79.5%) or acute cholecystitis (3.6%). Prophylactic CC occurred only in 15.5% of the cases. In our matched group analysis, we included 9,323 patients in each arm. The complication rate at Day 90 after surgery was greater in the CC arm [OR 1.3 (1.2–1.5), P<0.001], independantly of the reason of the CC. At 18 months, there was a 0.1% risk of symptomatic gallstone migration and a 0.08% risk of biliary pancreatitis. At 9 years, 20.5±0.52% of patients underwent an interval cholecystectomy (IC). The likelihood of IC decreased from 5.4% per year to 1.7% per year after the first 18 monthsthe whole cohort, risk at 18 months of symptomatic gallstone migration was 0.1%, of pancreatitis 0.08%, and of angiocholitis 0.1%. Conclusion: CC during SG and GBP should be avoided. In case of asymptomatic gallstones after MBS, prophylactic cholecystectomy should not be recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Table 2 Ninety-day Complication Rates In the Matched Cohorts...mentioning

confidence: 99%

Risk-Benefit Balance of Simultaneous Gastric Bypass or Sleeve Gastrectomy and Concomitant Cholecystectomy

Marciniak

Lenne²,

Bruandet³

et al. 2023

Annals of Surgery

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“…Moreover, patients who underwent sleeve gastrectomy plus abdominal wall reconstruction had a higher rate of ventilation more than 48 hours, unplanned admission to the ICU, pulmonary embolism, deep vein thrombosis, and readmission, reintervention, and reoperation. 34…”

Section: Physical Conditioningmentioning

confidence: 99%

Prehabilitation and Nutrition in Hernia Surgery

Cadena-Semanate

Morrison

Guerrón

et al. 2021

Digestive Disease Interventions

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Ventral hernia repair (VHR) is among the most frequently performed surgical procedures in the United States. Despite advancements in surgical technique, a significant number of VHR patients experience postoperative complications and hernia recurrence. A key strategy to reduce VHR morbidity is patient optimization before surgery with prehabilitation protocols. Prehabilitation aims to improve patients' functional status with physical conditioning, nutritional intervention, and psychological support. In other surgical disciplines, prompt preoperative action has proven to significantly reduce the negative influence of modifiable comorbidities and accelerate recovery. In this article, we review the literature to assess the applicability and benefits of prehabilitation in elective VHR cases. A review of the available evidence identified obesity, hyperglycemia, and smoking as significant modifiable risk factors that negatively affect VHR outcomes. Prehabilitation has the potential to mitigate and control these comorbidities. Physical conditioning with aerobic, resistance, and inspiratory muscle training is beneficial. Nutritional intervention to control diabetes and in severely malnourished patients is especially important in patients undergoing concomitant gastrointestinal procedures with VHR. Reasonable targets for prehabilitation protocols in elective VHR include a body mass index of 35 kg/m2, HbA1C of 6.5% and tobacco abstinence for at least 4 weeks. Prophylactic measures to minimize the rates of incisional hernia after primary laparotomy repairs include mesh reinforcement and a suture to wound length ratio of at least 4:1.

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“…При анализе данных регистров пациентов различий в уровне осложнений либо не было, либо отмечалось их небольшое, но значимое увеличение при симультанной холецистэктомии (табл. 3) [11,13,[32][33][34][35].…”

Section: симультанные вмешательства в бариатрии симультанная холецистэктомияunclassified

Simultaneous surgeries in bariatric surgery (literature review)

Smirnov¹,

Stankevich²,

Панченков

et al. 2020

Journal of Clinical Practice

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Based on the available publications, the article presents an analysis of studies on the problem of simultaneous execution of cholecystectomy, ventral and paraesophageal hernia repair during bariatric intervention. If there is a clinical picture of chronic calculous cholecystitis, simultaneous cholecystectomy is justified and does not lead to a significant increase in the number of complications. In case of asymptomatic stone-bearing disease, the optimal tactic remains controversial, both surgical treatment and observation are possible. In the absence of gallstone disease, all patients after surgical correction of excess weight are shown to take ursodeoxycholic acid, while performing preventive cholecystectomy is not recommended. Simultaneous ventral hernia repair is justified only for small defects ( 10 cm) of the anterior abdominal wall. If a paraesophageal hernia is detected in patients with morbid obesity, bariatric surgery may be combined with cruroraphy.

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Are Concomitant Operations During Bariatric Surgery Safe? An Analysis of the MBSAQIP Database

Cited by 16 publications

References 21 publications

Risk-Benefit Balance of Simultaneous Gastric Bypass or Sleeve Gastrectomy and Concomitant Cholecystectomy

Risk-Benefit Balance of Simultaneous Gastric Bypass or Sleeve Gastrectomy and Concomitant Cholecystectomy

Prehabilitation and Nutrition in Hernia Surgery

Simultaneous surgeries in bariatric surgery (literature review)

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