How frequently and when do patients undergo cholecystectomy after bariatric surgery?
BACKGROUND
Rapid weight loss after bariatric surgery is associated with gallstone formation, and cholecystectomy is required in up to 15% of patients. Prophylactic cholecystectomy or prophylactic ursodiol administration in the postoperative period have been suggested to address this problem. The objectives of this study were to investigate the frequency and timing of cholecystectomies after bariatric surgery and to determine the associated risk factors in patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic adjustable gastric band (LAGB), or laparoscopic sleeve gastrectomy (LSG).


METHODS
Data prospectively collected in an institutional database were analyzed. Differences among the 3 procedures and the effects of ursodiol administration, patient demographic characteristics, postoperative weight loss, and individual surgeon practices on cholecystectomy rates were examined. Survival analysis and proportional hazard models were used.


RESULTS
Of 1398 patients, 109 (7.8%) underwent cholecystectomy with a median follow-up of 49 (range 12-103) months. Cholecystectomy frequency was 10.6% after LRYGB, significantly higher than 2.9% after LAGB (P < .001), and 3.5% after LSG (P = .004). The frequency was highest within the first 6 months (3.7%), but declined over time to < 1% per year after 3 years. Ursodiol administration did not affect cholecystectomy rates (P = .97), and significant intersurgeon variability was noted. Excess weight loss (EWL)>25% within the first 3 months was the strongest predictor of postoperative cholecystectomy (P<.001). Cox hazards model revealed 1.25 odds ratio per 10% EWL within 3 months, and odds ratio .77 per decade of life. In addition, white patients had 1.45 times higher cholecystectomy rates than did black patients. Preoperative body mass index, gender, and surgeon did not affect cholecystectomy rates.


CONCLUSIONS
Bariatric surgery is associated with a low frequency of postoperative cholecystectomy, which is highest early after surgery and mainly determined by the amount of EWL within the first 3 months. The results of the present study do not support routine prophylactic cholecystectomy at the time of bariatric surgery in asymptomatic patients.
Department of Surgery, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois.
Victor B
VB
Tsirline
Jackson Purchase Medical Center, Mayfield, Kentucky.
Zeid M
ZM
Keilani
Carolinas Healthcare System, Charlotte, North Carolina.
Sofiane
S
El Djouzi
Carolinas Healthcare System, Charlotte, North Carolina.
Ryan C
RC
Phillips
Carolinas Healthcare System, Charlotte, North Carolina.
Timothy S
TS
Kuwada
Carolinas Healthcare System, Charlotte, North Carolina.
Keith
K
Gersin
Carolinas Healthcare System, Charlotte, North Carolina.
Connie
C
Simms
Carolinas Healthcare System, Charlotte, North Carolina. Electronic address: dimitrios.stefanidis@carolinas.org.
Dimitrios
D
Stefanidis
D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
Bariatric surgery; Cholecystectomy; Cholelithiasis; Roux-en-Y gastric bypass; Sleeve gastrectomy