The following is a summary of “Risk-Benefit Balance of Simultaneous Gastric Bypass or Sleeve Gastrectomy and Concomitant Cholecystectomy,” published in the November 2023 issue of Surgery by Marciniak, et al.
For a study, researchers sought to figure out how important it is to simultaneously have cholecystectomy and laparoscopic metabolic bypass surgery (MBS). A rise in the number of gallstones has been linked to MBS because it causes people to lose a lot of weight. However, there was no agreement on the risk-to-benefit ratio of doing a cholecystectomy (CC) at the same time as MBS to avoid long-term problems with the bile ducts. Data from a national statistical database (PMSI) were used for this two-part nationwide retrospective cohort study. It was first compared in a paired study (propensity score) to how sick people were 90 days after getting MBS with or without CC. Second, they saw bile problems continue for up to 9 years after MBS in patients who had not had CC during MBS (at least 18 months).
The results showed that 289,627 people had either a sleeve gastrectomy (SG: 70%) or a gastric bypass (GBP: 30%) between 2013 and 2020. Symptomatic cholelithiasis (79.5%) or acute cholecystitis (3.6%) were the main signs of CC. Only 15.5% of the time did preventive CC happen. The Researchers used matched-group analysis and put 9323 patients in each arm. At day 90 after surgery, there were more complications in the CC group [odds ratio=1.3 (1.2–1.5), P<0.001], and it didn’t matter what the CC was for. At 18 months, there was a 0.1% chance of gallstones moving around and a 0.08% chance of biliary pancreatitis.
In the ninth year, 20.5±0.52% of patients had an intermediate cholecystectomy. The chance of having an interval cholecystectomy dropped from 5.4% per year to 1.7% per year after the first 18 months for the whole group. At 18 months, the risk of gallstone migration with symptoms was 0.1%, pancreatitis was 0.08%, and angiocholitis was 0.1%. In conclusion, you should not use CC during SG and GBP. If an individual has gallstones detected after a Magnetic Resonance Cholangiopancreatography (MRCP) or Magnetic Resonance Imaging (MRI) of the bile duct system (MBS) but remains asymptomatic, the decision to undergo a preventive cholecystectomy (surgical removal of the gallbladder) is not universally recommended.
Source: lww.com/annalsofsurgery/abstract/2023/11000/risk_benefit_balance_of_simultaneous_gastric.13.aspx