Should Cholecystectomy be Performed Simultaneously with Bariatric Surgery in Obesity Patients?

Abstract

Introduction: Asymptomatic cholelithiasis may be detected in the tests performed while obese patients are being prepared for surgery. Determining whether asymptomatic gallstones will cause enough symptoms after bariatric surgery to cause the patient to undergo cholecystectomy surgery will help in the decision to perform concomitant cholecystectomy. This study aimed to determine whether there is a marker to determine whether patients with preoperative cholelithiasis are likely to undergo cholecystectomy after bariatric surgery. Material and Methods: We retrospectively reviewed the files of 771 patients who underwent bariatric surgery for obesity in the Gastroenterology Surgery Clinic of a Tertiary Training and Research Hospital between January 2015 and November 2023. Patients with cholelithiasis before bariatric surgery were included in Group 1 if they had undergone cholecystectomy surgery after bariatric surgery and in Group 2 if they had not. Results: Cholelithiasis was detected in 168 (21.8%) of 771 patients whose charts were reviewed. Group 1 included 73 patients who had undergone cholecystectomy after bariatric surgery, and Group 2 included 90 patients who had not undergone cholecystectomy. There were significant differences between the two groups in terms of age, gender, height-weight ratio, hemoglobin, total cholesterol, low and high-density lipoprotein, triglycerides, gallbladder stone diameter (p=0.395, 0.828, 0.584, 0.660, 0.316, 0.461, 0.988, 0.476, 0.208, respectively). Discussions: Our study found that asymptomatic gallstones required surgery twice as often as in the general population. Age, gender, height-weight ratio, hemoglobin, total cholesterol, low and high-density lipoprotein, triglycerides, and gallbladder stone diameter did not affect asymptomatic gallstones becoming symptomatic to require surgery. Obese patients undergo cholecystectomy surgery after bariatric surgery at a much higher rate than the general population. Therefore, cholecystectomy simultaneously with bariatric surgery should be considered as an option in these patients.

Keywords

• bariatric surgery
• cholecystectomy
• obesity

References

1. 1. Gönüllü E, Yüksel A, Coşkun M, Harmantepe T, Fırtına G, Karaman K. Oversewing the Staple Line: Does It Safe to Prevent Leakage? J Laparoendosc Adv Surg Tech A. 2024;34(2):120–126.
2. 2. Astbury NM, Piernas C, Hartmann-Boyce J, Lapworth S, Aveyard P, Jebb SA. A systematic review and meta-analysis of the effectiveness of meal replacements for weight loss. Obes Rev. 2019;20:569–587.
3. 3. Sooriyaarachchi P, Jayawardena R, Pavey T, King NA. A low-calorie meal replacement improves body composition and metabolic parameters in shift workers with overweight and obesity: a randomized, controlled, parallel group trial. Nutr Metab. 2024;21:32.
4. 4. Anuk T, Köksal N, Avşar F, Allahverdi TD, Sülü B, Çakmur H. Our initial results related to bariatric surgery. Ege J Med. 2017;56:82–85.
5. 5. Bindal V, Agarwal P, Khaitan M, Prasad A, Peters ANC, Narwaria M, et al. An Indian multicentre real-world study on long-term quality of life outcomes following bariatric surgery. Clin Obes. 2024;e12693.
6. 6. Alshaikh AA, Mahmood SE, Riaz F, Assiri AS, Abdulrahman MA, Asiri MYA, et al. Knowledge of Diabetes Mellitus and Practices Regarding Lifestyle Factors and Diabetes Management in a General Adult Population of Aseer Region, Saudi Arabia. Diabetes Metab Syndr Obes. 2024;17:2775–2787.
7. 7. Patel A, Abu Dayyeh BK, Balasubramanian G, Hinton A, Krishna SG, Brethauer S, et al. The impact of bariatric surgery on admissions for gastrointestinal complications and conditions associated with obesity: A nationwide study. World J Surg. 2024;48:175–185.
8. 8. Yıldız Ş, Alphan E, Batar N. Comparison of eating attitudes and behaviors and body mass index changes in patients who had undergone sleeve gastrectomy. Kafkas J Med Sci. 2020;10:136–144.

9. 9. Patel H, Jepsen J. Gallstone Disease: Common Questions and Answers. Am Fam Physician. 2024;109:518–524.
10. 10. Shenoy R, Kirkland P, Hadaya JE, Tranfield MW, DeVirgilio M, Russell MM, et al. Management of symptomatic cholelithiasis: a systematic review. Syst Rev. 2022;11:267.
11. 11. Portincasa P, Di Ciaula A, Wang HH, Moschetta A, Wang DQ-H. Medicinal treatments of cholesterol gallstones: old, current and new perspectives. Curr Med Chem. 2009;16:1531–1542.
12. 12. Fehring L, Brinkmann H, Hohenstein S, Bollmann A, Dirks P, Pölitz J, et al. Timely cholecystectomy: important factors to improve guideline adherence and patient treatment. BMJ Open Gastroenterol. 2024;11(1):e001439.
13. 13. Hamad GG, Ikramuddin S, Gourash WF, Schauer PR. Elective cholecystectomy during laparoscopic Roux-en-Y gastric bypass: is it worth the wait? Obes Surg. 2003;13:76–81.
14. 14. Worni M, Guller U, Shah A, Gandhi M, Shah J, Rajgor D, et al. Cholecystectomy concomitant with laparoscopic gastric bypass: a trend analysis of the nationwide inpatient sample from 2001 to 2008. Obes Surg. 2012;22:220–229.
15. 15. Lee J-H, Han G, Kim YJ, Jung M-S, Choi D. A Technique for Simultaneous Cholecystectomy During Bariatric Surgery. JSLS. 2015;19(4):e2015. 00072.
16. 16. Trelles N, Gagner M. Sleeve Gastrectomy. Operative Techniques in General Surgery. 2007;9:123–131.
17. 17. Gurusamy KS, Samraj K. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Cochrane Database Syst Rev. 2006;30(6): CD005440.
18. 18. Erlinger S. Gallstones in obesity and weight loss. Eur J Gastroenterol Hepatol. 2000;12:1347–1352.
19. 19. Velidedeoğlu M, Kaya B. Asemptomatik safra kesesi taşı olan hastalarda kolesistektomi gerçekten gerekli mi? Haydarpasa Numune Med J. 2015;55(3):196–200.
20. 20. Kama NA, Doganay M, Dolapci M, Reis E, Atli M, Kologlu M. Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery. Surg Endosc. 2001;15:965–968.
21. 21. Muscogiuri G, Verde L, Vetrani C, Barrea L, Savastano S, Colao A. Obesity: a gender-view. J Endocrinol Invest. 2024;47:299–306.
22. 22. Kim MS, Song M, Kim S, Kim B, Kang W, Kim JY, et al. Causal effect of adiposity on the risk of 19 gastrointestinal diseases: a Mendelian randomization study. Obesity. 2023;31:1436–1444.
23. 23. Ozkan E, Yildiz MK, Cakir T, Gunay E, Eris C, Dulundu E, et al. Outcome analysis of laparoscopic cholecystectomy in patients 65 years and older. Ulus Cerrahi Derg. 2012;28:88.
24. 24. Kurtul N, Pençe S, Kocoglu H, Aksoy H, Capan Y. Serum lipid and lipoproteins in gallstone patients. Acta Medica. 2002;45:79–81.
25. 25. Völzke H, Baumeister SE, Alte D, Hoffmann W, Schwahn C, Simon P, et al. Independent risk factors for gallstone formation in a region with high cholelithiasis prevalence. Digestion. 2005;71:97–105.
26. 26. Sheng B, Zhao Q, Ma M, Zhang J. An inverse association of weight and the occurrence of asymptomatic gallbladder stone disease in hypercholesterolemia patients: a case-control study. Lipids Health Dis. 2020;19:228.
27. 27. Li VK, Pulido N, Fajnwaks P, Szomstein S, Rosenthal R, Martinez-Duartez P. Predictors of gallstone formation after bariatric surgery: a multivariate analysis of risk factors comparing gastric bypass, gastric banding, and sleeve gastrectomy. Surg Endosc. 2009;23(7):1640–4.
28. 28. Boerlage, T. C. C., Haal, S., Maurits de Brauw, L. et al. Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery: study protocol for a randomized controlled trial (UPGRADE trial) . BMC Gastroenterol 17, 164(2017)
29. 29. Stokes, Caroline Sarah, and Frank Lammert. “Excess Body Weight and Gallstone Disease. ” Visceral medicine vol. 37, 4(2021):254–260.