Risk-Benefit Balance of Simultaneous Gastric Bypass or Sleeve Gastrectomy and Concomitant Cholecystectomy

Abstract

Objective: To assess the relevance of concomitant laparoscopic metabolic bariatric surgery (MBS) and cholecystectomy. Summary background data: Because of the massive weight loss it induces, MBS is associated with an increase in the frequency of gallstones. However, no consensus yet exists on the risk-to-benefit ratio of a concomitant cholecystectomy (CC) during MBS to prevent long-term biliary complications. Methods: This nationwide retrospective cohort research was conducted in two parts using information from a national administrative database (PMSI). The 90-day morbidity of MBS with or without CC was first compared in a matched trial (propensity score). Second, we observed medium-term biliary complication following MBS when no CChad been performed during MBS up to 9 years after MBS (minimum 18 mo) Results: Between 2013 and 2020, 289,627 patients had a sleeve gastrectomy (SG: 70%) or a gastric bypass (GBP: 30%). The principal indications of CC were symptomatic cholelithiasis (79.5%) or acute cholecystitis (3.6%). Prophylactic CC occurred only in 15.5% of the cases. In our matched group analysis, we included 9,323 patients in each arm. The complication rate at Day 90 after surgery was greater in the CC arm [OR 1.3 (1.2–1.5), P<0.001], independantly of the reason of the CC. At 18 months, there was a 0.1% risk of symptomatic gallstone migration and a 0.08% risk of biliary pancreatitis. At 9 years, 20.5±0.52% of patients underwent an interval cholecystectomy (IC). The likelihood of IC decreased from 5.4% per year to 1.7% per year after the first 18 monthsthe whole cohort, risk at 18 months of symptomatic gallstone migration was 0.1%, of pancreatitis 0.08%, and of angiocholitis 0.1%. Conclusion: CC during SG and GBP should be avoided. In case of asymptomatic gallstones after MBS, prophylactic cholecystectomy should not be recommended.