Subsequent cholecystectomy rate after Bariatric surgery in morbid obesity patients: A Systematic review and Meta-Analysis

Ajaree Sattaratnamai, MD1, Noppawat Samankatiwat, MD1, Suthep Udomsawaengsup, MD2. 1Ratchaburi Hospital, 2King Chulalongkorn Memorial Hospital

Introduction: Recently, the rate of bariatric surgery in morbid obesity patients is continuously increasing. After bariatric surgery, rapid weight loss increases the risk to develop gallbladder disease. Gallbladder management in bariatric surgery is still controversial whether to perform cholecystectomy only in symptomatic patients or prophylactically. The purpose of this study is to review the studies about the rate of gallstone and the need of subsequent cholecystectomy after bariatric surgery.

Method: We conducted a MEDLINE, PubMed, EMBASE, SCOPUS, and Google Scholar search up to August, 2015. Two investigators independently searched all the studies about incidences of symptomatic gallstone and cholecystitis that warranted cholecystectomy after bariatric surgery were included in this meta-analysis. Comprehensive Meta-Analysis (Ver.3) was used to analyze the data.

Results: 21 studies met the inclusion criteria. 18 studies investigated in patients who underwent Roux-en-Y gastric bypass(RYGB), 2 studies of sleeve gastrectomy(SG) and 6 studies of adjustable gastric banding(AGB). Total number of patients is 13,627. The number of patients without previous or concomitant cholecystectomy is 7,505 in Roux-en-Y gastric bypass group, 285 in sleeve gastrectomy group and 1,677 in adjustable gastric banding group were studied. The indications for subsequent cholecystectomy are mostly symptomatic gallstone and acute cholecystitis. In Roux-en-Y gastric bypass group, the rate of subsequent cholecystectomy is 8.6%(95%CI, 6.2-11.7%) , in sleeve gastrectomy group is 4.7%(95%CI,1.6-12.8%), in adjustable gastric banding is 6.6 %(95%CI,3.6-12.0%). The rate of subsequent cholecystectomy has no significant difference when compared between AGB and RYGB, AGB and SG, SG and RYGB (p-value 0.29, 0.28 and 0.12 respectively). Overall, the rate of patients who need subsequent cholecystectomy is 7.8% (95%CI, 6.0-10.1%). The reasons for subsequent cholecystectomy are symptomatic gallstone 79.84%, acute cholecystitis 15.50%, common bile duct stone with obstructive jaundice 2.32%, biliary pancreatitis 2.32%.

Conclusion: From the meta-analysis, the rate of patients that required subsequent cholecystectomy after each group of bariatric surgery(RYGB, SG or AGB) has no significant difference and the rate of subsequent cholecystectomy in is low. Therefore, prophylactic cholecystectomy may be unnecessary for every patient at the time of bariatric surgery.

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