Incidence of Gallstone Formation and Cholecystectomy 10 Years After Bariatric Surgery
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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.
KeywordsGallstone 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.
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 was obtained from all individual participants included in the study.
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.
- 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
- 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.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
- 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.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