Comparison of cholecystectomy cases after Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding.
BACKGROUND
Rapid weight loss after bariatric surgery has been a factor of inducing gallstones postoperatively. Many studies have reported increased gallstone formation after laparoscopic Roux-en-Y gastric bypass (LRYGB). However, not many studies have compared symptomatic gallstone frequencies between LRYGB, laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB). The aim of our study is to evaluate symptomatic cholelithiasis cases requiring cholecystectomy after each bariatric procedure.


METHODS
Between January 2009 and August 2011, a total of 937 patients underwent bariatric surgery at our institution. Of these patients, 598 had primary LRYGB, 197 had LSG, and 142 had LAGB. We excluded patients with previous cholecystectomy or concomitant cholecystectomy at the time of bariatric procedure. A retrospective review of a prospectively collected database was performed for all patients.


RESULTS
Of 367 LRYGB patients, 5.7% (n = 21) had symptomatic gallstones. Of 115 LSG patients, 6.1% (n = 7) required cholecystectomy, and of 104 LAGB patients, .0% (n = 0) developed symptomatic gallstones. The differences in the occurrences of symptomatic gallstones between LRYGB and LSG were not statistically significant (P>.88). However, statistical significance was present between LRYGB and LAGB (P<.02), as well as between LSG and LAGB (P<.02). Mean percentage of excess weight loss (%EWL) at 24 months was 85.7%, 58.8%, and 38.3% in LRYGB, LSG, and LAGB patients, respectively. There was no complication related to the cholecystectomy procedure.


CONCLUSIONS
Frequency of symptomatic gallstones after LRYGB and LSG was not significantly different and after LAGB was significantly lower. Slow and less amount of weight loss would have contributed to the low rate of symptomatic gallstone formation in the LAGB patients.
Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
Rena C
RC
Moon
Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
Andre F
AF
Teixeira
Department of General Surgery, Orlando Regional Medical Center, Orlando Health, Orlando, Florida.
Christopher
C
DuCoin
Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
Sheila
S
Varnadore
Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida. Electronic address: muhammad.jawad@orlandohealth.com.
Muhammad A
MA
Jawad
D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D002763:Cholecystectomy; D005260:Female; D042882:Gallstones / Q000209:etiology* / Q000601:surgery*; D005743:Gastrectomy / Q000009:adverse effects; D015390:Gastric Bypass / Q000009:adverse effects; D015391:Gastroplasty / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery; D061646:Operative Time; D011446:Prospective Studies; D012189:Retrospective Studies
Cholecystectomy; Cholelithiasis; Gastric banding; Gastric bypass; Sleeve gastrectomy; Symptomatic gallstones