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Gallstones and Bariatric Surgery: To Treat or Not to Treat?

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Abstract

Background

Obesity and rapid weight loss after bariatric surgery are risk factors for gallstone disease.

Objectives

The present study sought to evaluate the feasibility of selective concomitant cholecystectomy only in patients with symptomatic disease and study risk factors for the development of symptomatic gallstones after bariatric surgery.

Methods

Between January 2010 and December 2012, 734 consecutive patients presenting to our institution underwent bariatric surgery. From these, 81 patients were excluded due to prior or concurrent cholecystectomy. The remaining 653 patients with in situ gallbladder were followed for 12 months and were clinically screened for symptomatic or complicated cholelithiasis. Clinical and demographic characteristics were compared at baseline and 12 months after surgery.

Results

Of the 653 patients with in situ gallbladder, only 24 (3.3 %) developed symptomatic gallstones and only nine presented complicated disease. None of the patients with asymptomatic disease at the time of surgery progressed to symptomatic or complicated disease. Patients who developed symptomatic disease were not significantly different, although there was a trend toward longer obesity evolution, lower insulin levels, and lower hepatic enzymes level. A multivariate regression analysis revealed that patients with gastric sleeve were more likely to develop symptomatic gallstones.

Conclusions

Although further studies are required, the management of gallstones in morbidly obese patients should not be different from normal-weight patients. Therefore, performing a laparoscopic cholecystectomy only in symptomatic patients is an effective approach and asymptomatic gallstones should not be treated at the time of bariatric surgery.

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Funding

This project was funded by FCT through a Grant from the Harvard Medical School Portugal Program—HMSP-ICJ/SAU- ICT/0007/2009.

Authors’ contribution

All authors have read and approved the final manuscript. Marina Morais played a major role in writing the manuscript and analyzing the patient’s data. Gil Faria and John Preto aided in the editing of the manuscript and analyzed the patient’s data. J. Costa-Maia aided in the editing of the manuscript and gave final approval for publishing of this version.

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Authors and Affiliations

  1. General Surgery Department, Sao Joao Medical Center, Porto, Portugal

    Marina Morais, John Preto & José Costa-Maia

  2. Center for Health Technology and Services Research (CINTESIS), Instituto de Ciências Biomédicas de Abel Salazar, Porto, Portugal

    Gil Faria

Authors
  1. Marina Morais
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  2. Gil Faria
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  3. John Preto
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  4. José Costa-Maia
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Corresponding author

Correspondence to Marina Morais.

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Conflict of interest

Dr. Marina Morais, Dr. Gil Faria, Dr. John Preto, and Dr. J. Costa-Maia declare that they have no competing interests.

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Morais, M., Faria, G., Preto, J. et al. Gallstones and Bariatric Surgery: To Treat or Not to Treat?. World J Surg 40, 2904–2910 (2016). https://doi.org/10.1007/s00268-016-3639-2

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  • DOI: https://doi.org/10.1007/s00268-016-3639-2

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