Risk Factors for Cholecystectomy After Laparoscopic Roux-En-Y Gastric Bypass

Sylke Haal,Yair I Z Acherman,Roeland Huijgen,Arnold W J M Van De Laar,Rogier P Voermans,Barbara A Hutten,Victor E A Gerdes,Djoeke Rondagh

doi:10.1007/s11695-019-04166-y

Abstract

BackgroundPatients who have undergone bariatric surgery are at risk for subsequent cholecystectomy. We aimed to identify risk factors for cholecystectomy after laparoscopic Roux-en-Y gastric bypass (LRYGB).MethodsWe conducted a retrospective case-control study of patients who underwent LRYGB between 2013 and 2015. Cases underwent cholecystectomy because of biliary symptoms after LRYGB. For each case, two controls were selected without subsequent cholecystectomy. Logistic regression analyses were used to identify risk factors.ResultsBetween 2013 and 2015, 1780 primary LRYGBs were performed. We identified 233 (13.1%) cases who had undergone cholecystectomy after a median (IQR) of 12 (8–17) months, and 466 controls. Female gender (OR (95% CI) 1.83 (1.06–3.17)), Caucasian ethnicity (OR (95% CI) 1.82 (1.10–3.02)), higher percent total weight loss (%TWL) at 12 months (OR (95% CI) 1.06 (1.04–1.09)), and preoperative pain syndrome (OR (95% CI) 2.72 (1.43–5.18)) were significantly associated with an increased risk for cholecystectomy. Older age (OR (95% CI) 0.98 (0.96–0.99)) and preoperative statin use were associated with a reduced risk (OR (95% CI) 0.56 (0.31–1.00)). A dose-effect relationship was found between the intensity of preoperative statin and risk for cholecystectomy.ConclusionsIn our study, higher %TWL and preoperative pain syndrome were associated with an increased risk for cholecystectomy besides the traditional risk factors female gender and Caucasian ethnicity. These factors can be used to identify high-risk patients, who might benefit from preventive measures. Whether statins can protect bariatric patients from developing gallstones should be investigated prospectively.

Highlights

MethodsPatients with morbid obesity are at risk for symptomatic gallstone disease and cholecystectomy after bariatric surgery [1]
We identified 233 (13.1%) cases who underwent a cholecystectomy because of biliary symptoms within 2 years after laparoscopic Roux-en-Y gastric bypass (LRYGB)
Our study focused on cholecystectomy because this is more relevant for clinical practice

Summary

Introduction

MethodsPatients with morbid obesity are at risk for symptomatic gallstone disease and cholecystectomy after bariatric surgery [1]. The increased risk on cholesterol gallstones after bariatric surgery involves several determinants including altered biliary cholesterol homeostasis during weight loss. Female gender (OR (95% CI) 1.83 (1.06–3.17)), Caucasian ethnicity (OR (95% CI) 1.82 (1.10–3.02)), higher percent total weight loss (%TWL) at 12 months (OR (95% CI) 1.06 (1.04–1.09)), and preoperative pain syndrome (OR (95% CI) 2.72 (1.43–5.18)) were significantly associated with an increased risk for cholecystectomy. Conclusions In our study, higher %TWL and preoperative pain syndrome were associated with an increased risk for cholecystectomy besides the traditional risk factors female gender and Caucasian ethnicity. These factors can be used to identify high-risk patients, who might benefit from preventive measures. Whether statins can protect bariatric patients from developing gallstones should be investigated prospectively

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