Predictive factors of biliary complications after laparoscopic sleeve gastrectomies and laparoscopic Roux-en-Y gastric bypass surgeries

Abstract

Background: Previous studies have confirmed the association between biliary disease and bariatric operations. Biliary complications may include cholecystitis, biliary pancreatitis, cholangitis, biliary polyps, biliary sludge and gallstones. It is believed that cholelithiasis is the result of increased biliary stasis due to alterations in the enterohepatic circulation and hormonal changes associated with weight loss. However, research regarding predictive factors other than the percentage of excess weight loss (EWL) is limited. In addition, preventive measures of gallstone formation and potential related complications are still debated. Aim: The goal of this article is to assess the predictive factors of biliary complications after laparoscopic sleeve gastrectomies (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in order to review the possible need for future surveillance via radiological studies. Method: ology: A retrospective review of 118 patients who underwent LSG and LRYGB between 2015 and 2016 in Jordan University Hospital (single centre) was performed in order to complete this cohort study. Patients with previous cholecystectomies or biliary disease prior to bariatric operations were excluded from the study. Utilizing the hospital's electronic records system, patients were contacted by telephone and were asked a series of questions listed in a custom-made questionnaire. Results: Mean age ± SD was 34.9 ± 12.0 years old (68.64% Females). Eleven patients (9.32%) underwent LRYGB, 100 patients underwent LSG and seven patients underwent both, with a preoperative mean body mass index (BMI) ± SD of 45.2 ± 6.3. 29 patients (24.58%) developed postoperative biliary complications. The main biliary complications were as follows: biliary pancreatitis (0.85%), biliary polyps (0.85%), biliary sludge (0.85%), cholecystitis/gallstones (22.03%). Conclusion: In conclusion, it was found that approximately 24.58% of patients have post-operative late biliary complications. Of these patients, predictive factors other than EWL were not significant enough to recommend prophylactic screening via radiological studies. Highlights