Taylor J Smart, MD1, Noah J Switzer, MD1, Richdeep S Gill, MD, PhD, FRCSC1, Xinzhe Shi, MPH2, Christopher de Gara, MD, FRCSC1, Daniel W Birch, MD, FRCSC1, Shahzeer Karmali, MD, MPH, FRCSC1. 1Department of Surgery, University of Alberta, 2Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital
Objective. Bariatric surgery leads to significant weight reduction in the morbidly obese. However, rapid weight loss has been associated with an increased risk for the development of gallstones. Different modalities have been advocated to manage this complication including synchronous cholecystectomy, prophylactic medical therapy and high-fat diets. The purpose of this study is to systematically review the literature on the benefit of using gallstone dissolution medical therapy as prophylaxis therapy following bariatric surgery.
Methods. A comprehensive search of electronic databases (e.g., MEDLINE, EMBASE, SCOPUS, Web of Science and the Cochrane Library) using search terms “bariatric or gastric bypass” AND “gall bladder, or gallstone, or cholecystitis, or cholecystectomy, or bile, or biliary” was completed. All randomized controlled trials, non-randomized comparison study, and case series were included. All human studies limited to English were included. Two independent reviewers screened abstracts, reviewed full text versions of all studies classified and extracted data. All studies included in the systematic review were assessed independently by two reviewers for methodological quality using the Cochrane Risk of Bias (RoB) tools. Disagreements were resolved by re-extraction, or third party adjudication. 1928 titles were identified through primary search and 826 titles or abstracts were screened after removing duplicates.
Results. 28 articles consisting of 32,147 patients were included in the systematic review. The group with no dissolution therapy had a mean incidence of cholelithiasis postoperatively of 31.5%, 30.8%, 9.1% at 6 months, 12 months, and 24 months respectively. In the group of patients who did receive dissolution therapy, patients had a lower mean incidence of cholelithiasis following bariatric surgery of 5.3%, 24.9%, and 5% at those same intervals.
The mean incidence of cholecystectomy in the no dissolution therapy group was 5.3%, 9.7%, and 4.8% at 6 months, 12 months, and 24 months respectively. Those who did receive dissolution therapy had a lower mean incidence of cholecystectomy of 0%, 14.6%, and 4.7% at those same intervals.
Conclusion. Prophylactic gallbladder dissolution therapy following bariatric surgery appears to be correlated with a decreased incidence of gallstones and need for cholecystectomy. Further primary studies are needed to evaluate this therapy to significance.