Bariatric Surgery and Biliary Disease: Does the Type of Surgery Play a Role?

Colin B Webb, MD, Patricia L Eichhorn, MD, Clarissa Sutter, Joseph A Ewing, MS, Allyson L Hale, John D Scott, MD. Greenville Health System

Introduction: Biliary disease is a common complication in bariatric surgery patients. The purpose of this study is to determine whether an association exists between the type of bariatric surgery performed and the incidence of biliary disease.

Methods and Procedures: We retrospectively reviewed all vertical sleeve gastrectomy (n=300), roux en-Y gastric bypass (n=2120), and gastric lap band procedures (134) performed at our institution between 2002 and 2012. Primary endpoints included the type of surgery, the incidence of biliary disease, the percent of excess weight loss (EWL), and the number of days between bariatric surgery and the cholecystectomy. The type of surgery, the incidence of biliary disease, and the number of days/dates were collected via chart reviews. Incidence of biliary disease was identified by subsequent cholecystectomy. The EWL was measured by the percent change in body mass index (BMI); patients BMIs were recorded at the time of the bariatric surgery and at the time of presentation with biliary disease. Chi square tests were used to test differences in incidence of biliary disease, median weight loss, and median time to cholecystectomy. P-values > 0.05 were considered indicative of statistical significance.

Results: Roughly 5.2% (7 of 134) of our gastric lap band patients developed biliary disease and required subsequent cholecystecomies, compared to 3.9% (82 of 2120) for roux en-Y gastric bypass and 2.3% (7 of 300) for sleeve gastrectomies. Our results showed no statistical difference in the incidence of biliary disease by type of bariatric surgery (p-value=0.279). Furthermore, we found no statistical difference in the median percent of excess weight loss (p-value=0.446) or in the median number of days (p-value=0.296) by type of surgery, as shown in Table 1.

Conclusions: Our results suggest there to be no association between the type of bariatric surgery performed and the incidence of biliary disease.

Table 1. Change in BMI and Time Between Surgeries, By Bariatric Surgery
Bypass Sleeve Band P-value
Total Procedures 2120 300 134
Cholecystectomies (%) 82 (3.9) 7 (2.9) 7 (5.2) 0.279
Change in BMI, Median (IQR) 27 (18.3, 36.5) 15 (13.6, 22.9) 23.8 (23.4, 24.8) 0.446
Time Between (Days), Median (IQR) 343 (142, 632) 219 (126.5, 292) 624 (329.5, 837) 0.296

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