Jerry T Dang, MD1, Chantalle Grant, MD1, Noah Switzer, MD, MPH2, Warren Sun, MD1, Daniel W Birch, MD, MSc1, Shahzeer Karmali, MD, MPH1. 1University of Alberta, 2Ohio State University
Introduction: The objective of this study was to examine the safety of bariatric surgery with concurrent laparoscopic cholecystectomy (LC). Patients with obesity are at increased risk of gallstone disease and at an even higher risk after bariatric surgery due to sudden weight loss. Although prophylactic cholecystectomy is seldom performed concurrently with bariatric surgery, in patients with gallstone disease, there is debate on the timing of cholecystectomy and whether it should be performed concurrently with bariatric surgery. Previous studies have demonstrated safety with concurrent bariatric surgery and LC.
Methods and Procedures: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) is a clinically-rich database that captures variables specific to bariatric surgery from 791 centres in the United States and Canada. Data was extracted from the 2015 and 2016 participant use files. Patients undergoing primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) were included. Laparoscopic cholecystectomy was identified using Current Procedural Terminology codes 43281 and 43282.
Propensity scores were calculated for those undergoing concurrent LC as a function of age, sex, body mass index (BMI), procedure, comorbidities, functional status and medical history. One-to-one propensity-matched cohorts were then determined using nearest-neighbor matching within a specified caliper distance set at 0.2 standard deviations. This eliminated approximately 99% of bias due to measured confounders. The primary outcome was 30-day major complications.
Results: A total of 189,560 LSG and 75,492 LRYGB were included. Only 5909 (2.2%) of procedures had concurrent LC. In the unmatched cohort, there were baseline differences in age, sex, and comorbidities. With propensity matching, 5895 pairs were selected with statistically similar preoperative characteristics. The rate of 30-day major complications was significantly higher in the concurrent LC cohort (4.63% vs 3.70%, p = 0.011). In the LC cohort, there were also higher rates of cardiac events (0.12 vs 0.02%, p = 0.034) and acute renal failure (0.22 vs 0.05%, p = 0.012). However, rates of bleed, leak, reoperation, readmission and death were similar. Operative time was longer with concurrent LC (118.4 ± 55.7 vs 90.0 ± 48.8 minutes, p < 0.001).
Conclusion: This is the first analysis of a large cohort that has demonstrated increased morbidity with concurrent LC. Although prophylactic cholecystectomy is seldom performed during bariatric surgery, patients with gallstone disease may be better suited to have cholecystectomy performed before or after bariatric surgery due to higher major complication rates.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94710
Program Number: S062
Presentation Session: Residents and Fellows Session
Presentation Type: ResFel