Obesity Surgery

, Volume 25, Issue 7, pp 1171–1176 | Cite as

Incidence of Gallstone Formation and Cholecystectomy 10 Years After Bariatric Surgery

  • Andreas Melmer
  • Wolfgang Sturm
  • Bernhard Kuhnert
  • Julia Engl-Prosch
  • Claudia Ress
  • Alexander Tschoner
  • Markus Laimer
  • Elisabeth Laimer
  • Matthias Biebl
  • Johann Pratschke
  • Herbert Tilg
  • Christoph Ebenbichler
Original Contributions



Rapid weight loss is a risk factor for gallstone formation, and postoperative treatment options for gallstone formation are still part of scientific discussion. No prospective studies monitored the incidence for gallstone formation and subsequent cholecystectomy after bariatric surgery longer than 5 years. The aim of the study was to determine the incidence of gallstone formation and cholecystectomy in bariatric patients over 10 years.

Materials and methods

One hundred nine patients were observed over 10 years after laparoscopic gastric banding or gastric bypass/gastric sleeve. The incidence of gallstone formation and cholecystectomy was correlated to longitudinal changes in anthropometric parameters.


In total, 91 female and 18 male patients were examined. Nineteen patients had postoperative gallstone formation, and 12 female patients required cholecystectomy. The number needed to harm for gallstone formation was 7.1 and 2.3 cases in the banding group and gastric bypass/gastric sleeve group, respectively. The number needed to harm for cholecystectomy was 11.6 and 2.5 cases in the banding group and the gastric bypass/gastric sleeve group, respectively. Weight loss was higher in patients requiring subsequent cholecystectomy. Mean follow-up to cholecystectomy was 21.5 months with the latest operation after 51 months.


Female gender and rapid weight loss were major risk factors for postoperative cholelithiasis. Ultrasound examinations within 2 to 5 years are recommended in every patient, independent of bariatric procedure. Pharmacologic treatment should be considered in high risk patients within 2 to 5 years to prevent postoperative cholelithiasis. This helps to optimize patient care and lowers postoperative morbidity.


Gallstone formation Bariatric surgery Cholecystectomy Obesity Weight loss 



The expert technical assistance of Dr. Karin Salzmann is gratefully acknowledged. This study was supported by the Austrian Science Fund (FWF) KLI 348 and by the Austrian Science Fund ZFP 266730.

The corresponding author, Prof. Dr. Christoph Ebenbichler, had full access to all data in the study and had the final responsibility for the decision to submit for publication.

Authors Contributions

Andreas Melmer was involved in manuscript preparation, data analysis, patients’ recruitment, and clinical examination. Wolfgang Sturm performed the ultrasound examinations; Bernhard Kuhnert was involved in manuscript preparation and data analysis; Julia Engl-Prosch was involved in manuscript preparation, patients’ recruitment and clinical examination; Claudia Ress was involved in patients’ recruitment and clinical examination; Alexander Tschoner was involved in patients recruitment and clinical examination; Markus Laimer was involved in manuscript preparation; Elisabeth Laimer performed the bariatric surgery; Matthias Biebl performed the bariatric surgery; Johann Pratschke performed the bariatric surgery; Herbert Tilg was involved in manuscript preparation; and Christoph Ebenbichler is the principal investigator of the study and was involved in manuscript preparation, patients’ recruitment, and clinical examination.

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Gustafsson U, Benthin L, Granstrom L, Groen AK, Sahlin S, Einarsson C. Changes in gallbladder bile composition and crystal detection time in morbidly obese subjects after bariatric surgery. Hepatology. 2005;41(6):1322–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Maurer KR, Everhart JE, Ezzati TM, Johannes RS, Knowler WC, Larson DL, et al. Prevalence of gallstone disease in Hispanic populations in the United States. Gastroenterology. 1989;96(2 Pt 1):487–92.PubMedGoogle Scholar
  3. 3.
    Barbara L, Sama C, Morselli Labate AM, Taroni F, Rusticali AG, Festi D, et al. A population study on the prevalence of gallstone disease: the Sirmione Study. Hepatology. 1987;7(5):913–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Attili AF, Carulli N, Roda E, Barbara B, Capocaccia L, Menotti A, et al. Epidemiology of gallstone disease in Italy: prevalence data of the Multicenter Italian Study on Cholelithiasis (M.I.COL.). Am J Epidemiol. 1995;141(2):158–65.PubMedGoogle Scholar
  5. 5.
    Everhart JE, Khare M, Hill M, Maurer KR. Prevalence and ethnic differences in gallbladder disease in the United States. Gastroenterology. 1999;117(3):632–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Mabee TM, Meyer P, DenBesten L, Mason EE. The mechanism of increased gallstone formation in obese human subjects. Surgery. 1976;79(4):460–8.PubMedGoogle Scholar
  7. 7.
    Shiffman ML, Sugerman HJ, Kellum JM, Moore EW. Changes in gallbladder bile composition following gallstone formation and weight reduction. Gastroenterology. 1992;103(1):214–21.PubMedGoogle Scholar
  8. 8.
    Weinsier RL, Wilson LJ, Lee J. Medically safe rate of weight loss for the treatment of obesity: a guideline based on risk of gallstone formation. Am J Med. 1995;98(2):115–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Liddle RA, Goldstein RB, Saxton J. Gallstone formation during weight-reduction dieting. Arch Intern Med. 1989;149(8):1750–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Warschkow R, Tarantino I, Ukegjini K, Beutner U, Guller U, Schmied BM, et al. Concomitant cholecystectomy during laparoscopic Roux-en-Y gastric bypass in obese patients is not justified: a meta-analysis. Obes Surg. 2013;23(3):397–407.PubMedCrossRefGoogle Scholar
  11. 11.
    Mittermair RP, Weiss H, Nehoda H, Kirchmayr W, Aigner F. Laparoscopic Swedish adjustable gastric banding: 6-year follow-up and comparison to other laparoscopic bariatric procedures. Obes Surg. 2003;13(3):412–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Pontiroli AE, Pizzocri P, Giacomelli M, Marchi M, Vedani P, Cucchi E, et al. Ultrasound measurement of visceral and subcutaneous fat in morbidly obese patients before and after laparoscopic adjustable gastric banding: comparison with computerized tomography and with anthropometric measurements. Obes Surg. 2002;12(5):648–51.PubMedCrossRefGoogle Scholar
  13. 13.
    Montero PN, Stefanidis D, Norton HJ, Gersin K, Kuwada T. Reported excess weight loss after bariatric surgery could vary significantly depending on calculation method: a plea for standardization. Surg obes Relat Dis Off J American Soc Bariatric Surg. 2011;7(4):531–4.CrossRefGoogle Scholar
  14. 14.
    Ahmed AR, O’Malley W, Johnson J, Boss T. Cholecystectomy during laparoscopic gastric bypass has no effect on duration of hospital stay. Obes Surg. 2007;17(8):1075–9.PubMedCrossRefGoogle Scholar
  15. 15.
    D’Hondt M, Sergeant G, Deylgat B, Devriendt D, Van Rooy F, Vansteenkiste F. Prophylactic cholecystectomy, a mandatory step in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass? J Gastrointest Surg. 2011;15(9):1532–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Papasavas PK, Gagne DJ, Ceppa FA, Caushaj PF. Routine gallbladder screening not necessary in patients undergoing laparoscopic Roux-en-Y gastric bypass. Surg obes Relat Dis Off J American Soc Bariatric Surg. 2006;2(1):41–6. discussion 6–7.CrossRefGoogle Scholar
  17. 17.
    Patel JA, Patel NA, Piper GL, Smith 3rd DE, Malhotra G, Colella JJ. Perioperative management of cholelithiasis in patients presenting for laparoscopic Roux-en-Y gastric bypass: have we reached a consensus? Am Surg. 2009;75(6):470–6. discussion 6.PubMedGoogle Scholar
  18. 18.
    Wudel Jr LJ, Wright JK, Debelak JP, Allos TM, Shyr Y, Chapman WC. Prevention of gallstone formation in morbidly obese patients undergoing rapid weight loss: results of a randomized controlled pilot study. J Surg Res. 2002;102(1):50–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Amaral JF, Thompson WR. Gallbladder disease in the morbidly obese. Am J Surg. 1985;149(4):551–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient–2013 update: cosponsored by American Association Of Clinical Endocrinologists, The Obesity Society, and American Society For Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21 Suppl 1:S1–27.CrossRefGoogle Scholar
  21. 21.
    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.PubMedCrossRefGoogle Scholar
  22. 22.
    Ransohoff DF, Gracie WA, Wolfenson LB, Neuhauser D. Prophylactic cholecystectomy or expectant management for silent gallstones. A decision analysis to assess survival. Ann Intern Med. 1983;99(2):199–204.PubMedCrossRefGoogle Scholar
  23. 23.
    Wright BE, Cass OW, Freeman ML. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc. 2002;56(2):225–32.PubMedCrossRefGoogle Scholar
  24. 24.
    Baron TH, Song LM, Ferreira LE, Smyrk TC. Novel approach to therapeutic ERCP after long-limb Roux-en-Y gastric bypass surgery using transgastric self-expandable metal stents: experimental outcomes and first human case study (with videos). Gastrointest Endosc. 2012;75(6):1258–63.PubMedCrossRefGoogle Scholar
  25. 25.
    Sugerman HJ, Brewer WH, Shiffman ML, Brolin RE, Fobi MA, Linner JH, et al. A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypass-induced rapid weight loss. Am J Surg. 1995;169(1):91–6. discussion 6–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Moon RC, Teixeira AF, DuCoin C, Varnadore S, Jawad MA. Comparison of cholecystectomy cases after Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding. Surg obes Relat Dis Off J American Soc Bariatric Surg. 2014;10(1):64–8.CrossRefGoogle Scholar
  27. 27.
    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(2):220–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Andreas Melmer
    • 1
  • Wolfgang Sturm
    • 1
  • Bernhard Kuhnert
    • 1
  • Julia Engl-Prosch
    • 1
  • Claudia Ress
    • 1
  • Alexander Tschoner
    • 1
  • Markus Laimer
    • 1
  • Elisabeth Laimer
    • 2
  • Matthias Biebl
    • 3
  • Johann Pratschke
    • 3
  • Herbert Tilg
    • 1
  • Christoph Ebenbichler
    • 1
  1. 1.Department of Internal Medicine IMedical University of InnsbruckInnsbruckAustria
  2. 2.Department of General, Thoracic and Transplant SurgeryMedical University of InnsbruckInnsbruckAustria
  3. 3.Department for General, Visceral and Transplantation SurgeryUniversity Hospital ChariteBerlinGermany

Personalised recommendations