A Prospective Study of the Conservative Management of Asymptomatic Preoperative and Postoperative Gallbladder Disease in Bariatric Surgery.
Bariatric surgery is the most effective therapy for weight loss in patients with morbid obesity. One of the most common long-term complications includes cholelithiasis. There is not a clear consensus in how to treat an asymptomatic gallbladder disease before and after bariatric surgery.



Prospective study with every patient submitted to bariatric surgery from 2012 to 2014. The gallbladder status was assessed with an ultrasound before and after surgery (12 months), and a conservative management was conducted for patients with asymptomatic disease (preoperative and de novo); the need for delayed cholecystectomy was reported. Secondarily, an analysis of weight loss (%EWL) and gallbladder status was performed.



Two-hundred and two bariatric surgeries were performed. The global incidence of preoperative gallbladder disease was 34.3 %, with 14.2 % presenting sludge, 20.1 % asymptomatic gallstones, and 2.3 % symptomatic gallstones. The final analysis was based on 146 patients; female sex comprised 81.1 % of cases with a mean age of 38.5 years. After 12 months, de novo gallbladder disease was observed in 21.2 %. The overall rate of cholecystectomy because of symptomatic disease after 12 months was 3.4 % (2 % developed acute cholecystitis). There were no differences in %EWL between patients with de novo gallbladder disease and those without.



Conservative management of asymptomatic gallbladder disease in candidates to bariatric surgery is safe and can be offered in every case, based on the low percentage of patients requiring further cholecystectomy after 12 months. Also, a conservative management can be offered to patients developing de novo sludge/cholelithiasis without related symptoms.
The Obesity Clinic at "Hospital General Tláhuac", Avenida La Turba #655, Col. Villa Centroamericana y del Caribe, Del. Tláhuac, CP 13278, Mexico City, Mexico.
Omar
O
Pineda
The Obesity Clinic at "Hospital General Tláhuac", Avenida La Turba #655, Col. Villa Centroamericana y del Caribe, Del. Tláhuac, CP 13278, Mexico City, Mexico.
Hernán G
HG
Maydón
The Obesity Clinic at "Hospital General Tláhuac", Avenida La Turba #655, Col. Villa Centroamericana y del Caribe, Del. Tláhuac, CP 13278, Mexico City, Mexico.
Mónica
M
Amado
The Obesity Clinic at "Hospital General Tláhuac", Avenida La Turba #655, Col. Villa Centroamericana y del Caribe, Del. Tláhuac, CP 13278, Mexico City, Mexico.
Elisa M
EM
Sepúlveda
The Obesity Clinic at "Hospital General Tláhuac", Avenida La Turba #655, Col. Villa Centroamericana y del Caribe, Del. Tláhuac, CP 13278, Mexico City, Mexico.
Lizbeth
L
Guilbert
The Obesity Clinic at "Hospital General Tláhuac", Avenida La Turba #655, Col. Villa Centroamericana y del Caribe, Del. Tláhuac, CP 13278, Mexico City, Mexico.
Omar
O
Espinosa
The Obesity Clinic at "Hospital General Tláhuac", Avenida La Turba #655, Col. Villa Centroamericana y del Caribe, Del. Tláhuac, CP 13278, Mexico City, Mexico. zerrweck@yahoo.com.
Carlos
0000-0001-7358-2652
C
Zerrweck
D000328:Adult; D058070:Asymptomatic Diseases; D050110:Bariatric Surgery / Q000009:adverse effects* / Q000706:statistics & numerical data; D002763:Cholecystectomy / Q000379:methods / Q000706:statistics & numerical data; D000072700:Conservative Treatment / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005705:Gallbladder Diseases / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D042882:Gallstones / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies
Bariatric surgery; Cholecystectomy; Cholecystitis; Cholelithiasis; Gallbladder; Gallstones; Laparoscopic gastric bypass; Laparoscopic sleeve gastrectomy; Sludge; Weight loss