Original article
Incidence of cholecystectomy after bariatric surgery

https://doi.org/10.1016/j.soard.2018.03.028Get rights and content

Abstract

Background

Bariatric surgery predisposes patients to development of cholelithiasis, and therefore the need of a subsequent cholecystectomy; however, the incidence of cholecystectomy after bariatric surgery is debated.

Objective

The purpose of our study is to assess the incidence of cholecystectomy after 3 of the most common bariatric procedures.

Setting

University Hospital, involving a large database in New York State.

Methods

The Statewide Planning and Research Cooperative System administrative longitudinal database was used to identify all patients undergoing Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB) between 2004 and 2010. Through the use of a unique identifier patients were followed to evaluate for the need of a subsequent cholecystectomy over at least 5 years. Cox proportional hazard regression analysis was used to identify risk factors for subsequent cholecystectomy.

Results

During this time period, there were 15,301 LAGB procedures, 19,996 RYGB, and 1650 SG. There were 989 (6.5%) patients who underwent cholecystectomy after LAGB, 1931 (9.7%) patients after RYGB, and 167 (10.1%) after SG. Approximately one quarter of follow-up cholecystectomies were performed at the same institutions. LAGB and RYGB were less likely to have a subsequent cholecystectomy compared with SG (hazard ratio .5, 95% confidence interval .4–.6 for LAGB; and hazard ratio .7, 95% confidence interval .6–.9 for RYGB). Risk factors for a subsequent cholecystectomy included age, sex, race, and some co-morbidities and complications (P<.05) based on a multivariable Cox proportional hazard model.

Conclusion

The rate of cholecystectomy after LAGB, RYGB, and SG was 6.5%, 9.7% and 10.1%, respectively. Patients should be counseled preoperatively about this risk and biliary prophylaxis should be contemplated.

Section snippets

Methods

The New York State Department of Health and the institutional review board approved this study. The Statewide Planning and Research Collaborative System administrative longitudinal database was used to identify all patients undergoing RYGB, sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB) between 2004 and 2010 through the use of the International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes. Patients were identified

Results

During this time period, there were 15,301 LAGB patients, 19,996 RYGB, and 1650 SG who had follow-up data and did not have cholecystectomy at the time of bariatric surgery or before that since 2000. Cholecystectomy was performed at the time of original surgery or before that in 1143 of LAGB patients (7.0%), 2772 in RYGB group (12.2%), and 131 patients in SG group (7.4%). Thus, they were excluded in the mentioned patients above. There were 989 (6.5%) patients who underwent cholecystectomy after

Discussion

It is debatable whether routine cholecystectomy should be performed at the time of the original weight loss procedure. There are no current guidelines for prophylactic cholecystectomy; however, concomitant cholecystectomy is not performed routinely during most primary bariatric procedures. Many are arguing that despite the higher prevalence of gallstones in this patient population, the rate of subsequent cholecystectomy remains low, while concomitant cholecystectomy leads to potentially higher

Conclusion

The rate of cholecystectomy after LAGB, RYGB, and SG was 6.5%, 9.7% and 10.1%, respectively. After accounting for other variables, patients after either LAGB or RYGB were less likely to undergo a subsequent cholecystectomy. In addition, CBD injury had a higher rate of .12% during subsequent cholecystectomy. Patients should be counseled preoperatively about this risk. The risks and benefits of ursodiol or prophylactic cholecystectomy should also be considered.

Disclosures

Dr. Pryor is a speaker for Gore, Ethicon, Medtronic, Merck, and Stryker. She has received research support from Obalon and Baronova. There are no other conflicts of interest or financial disclosures for any of the authors.

Acknowledgments

We acknowledge the biostatistical consultation and biostatistical support provided by the Biostatistical Consulting Core at School of Medicine, Stony Brook University.

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Accepted for an oral presentation at Obesity Week, ASMBS 2017, Washington, D.C.

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