Cholecystectomy in Patients Submitted to Bariatric Procedure: A Systematic Review and Meta-analysis

Abstract

Weight loss following bariatric surgery increases risk for biliary stones. This study performed a meta-analysis evaluating cholecystectomy risks in bariatric patients. A systematic review and meta-analysis were performed. We evaluated the incidence rate for biliary complications in patients followed after bariatric surgery. We compared the risks for mortality, complications, and in hospital stay among patient submitted to cholecystectomy before, concomitantly with or after bariatric surgery, as well as patients submitted to bariatric surgery and cholecystectomy, and patients submitted only to bariatric surgery in order to evaluate when to perform cholecystectomy in morbidly obese patients. The incidence rate of biliary complications was 5.54 cases/1000 patient year. The addition of cholecystectomy to bariatric surgery resulted in an increased risk for complications (RD = 0.02). The risk for complications (RD = - 0.09) and reoperation (RD = - 0.02) was lower when performed concomitantly with bariatric surgery compared to post-bariatric procedure. Prophylactic cholecystectomy may be avoided. Patients submitted to bariatric surgery have low incidence rate of biliary complications, and concomitant cholecystectomy increases the risk for postoperative complications and operative time. If cholecystectomy is not indicated, patients should be carefully followed with attention for biliary complications, once cholecystectomy performed post-bariatric surgery is at higher risk for complications and reoperations.

Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography for choledocholithiasis after Roux-en-Y gastric bypass: A case report

“…This extended time in the operating room, in combination with the additional measures required to manage postoperative complications, substantially increases the cost of weight-loss surgery, which is typically shouldered by the patient. UDA prophylaxis has been shown to reduce the incidence of biliary complications, supporting our initial choice [17].…”

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

“…In general, cholecystectomy should be reserved for patients with symptomatic biliary disease, as the risk of needing a postoperative cholecystectomy is 6 to 10% . In asymptomatic patients with known gallstones and a history of RYGB or BPD/DS, prophylactic cholecystectomy may be considered to avoid choledocholithiasis, since traditional endoscopic retrograde cholangiopancreatography can no longer be performed in these patients . Since the aggregate complication risk of cholecystectomy is lower when performed prior, compared with during or after RYGB, the appropriate use of preoperative cholecystectomy and optimization of preventive measures postoperatively are critical .…”

Laparoscopic assisted ERCP in patient with Roux-en-Y gastric bypass. A case report

“…Moreover, Altieri et al [ 10 ] concluded that just 9.7% of patients that underwent RYGB needed a cholecystectomy and that a concurrent cholecystectomy during bariatric surgery is not justified. Most papers agree that cholecystectomy should be performed only in patients who already had biliary symptoms in the past or at time of bariatric surgery [ 10 , 9 , 11 , 12 ]. As far as concerns the matter of whether to perform a prophylactic laparoscopic cholecystectomy during the bypass procedure, in order to prevent biliary stones in the biliary tree, literature is divided.…”