Risk Factors for Cholecystectomy After Laparoscopic Roux-En-Y Gastric Bypass

Abstract

Background Patients who have undergone bariatric surgery are at risk for subsequent cholecystectomy. We aimed to identify risk factors for cholecystectomy after laparoscopic Roux-en-Y gastric bypass (LRYGB). Methods We conducted a retrospective case-control study of patients who underwent LRYGB between 2013 and 2015. Cases underwent cholecystectomy because of biliary symptoms after LRYGB. For each case, two controls were selected without subsequent cholecystectomy. Logistic regression analyses were used to identify risk factors. Results Between 2013 and 2015, 1780 primary LRYGBs were performed. We identified 233 (13.1%) cases who had undergone cholecystectomy after a median (IQR) of 12 (8-17) months, and 466 controls. Female gender (OR (95% CI) 1.83 (1.06-3.17)), Caucasian ethnicity (OR (95% CI) 1.82 (1.10-3.02)), higher percent total weight loss (%TWL) at 12 months (OR (95% CI) 1.06 (1.04-1.09)), and preoperative pain syndrome (OR (95% CI) 2.72 (1.43-5.18)) were significantly associated with an increased risk for cholecystectomy. Older age (OR (95% CI) 0.98 (0.96-0.99)) and preoperative statin use were associated with a reduced risk (OR (95% CI) 0.56 (0.31-1.00)). A dose-effect relationship was found between the intensity of preoperative statin and risk for cholecystectomy. Conclusions In our study, higher %TWL and preoperative pain syndrome were associated with an increased risk for cholecystectomy besides the traditional risk factors female gender and Caucasian ethnicity. These factors can be used to identify high-risk patients, who might benefit from preventive measures. Whether statins can protect bariatric patients from developing gallstones should be investigated prospectively.

Risk Factors for Symptomatic Gallstone Disease and Gallstone Formation After Bariatric Surgery

“…The presence of a pain syndrome was also identified as risk factor for the occurrence of symptomatic gallstone disease after bariatric surgery, which is in line with our previous finding that a pain syndrome increases the chance of undergoing cholecystectomy after bariatric surgery [30] In our previous paper, we speculated that patients with a pain syndrome are more likely to visit a doctor in case they experience abdominal pain, often resulting in imaging of the abdomen. We all know that postoperatively, the probability to find gallstones during imaging is high.…”

“…Preoperatively, data on demographics, presence of comorbidity, and preoperative medication use were collected. Hypertension, type 2 diabetes, and pain syndrome were defined as earlier described [30]. Dyslipidemia was defined as the presence of at least one of the following: known dyslipidemia, use of lipid-lowering drugs, a high-density lipoprotein cholesterol ≤ 0.9 mmol/L, lowdensity lipoprotein cholesterol ≥ 5.0 mmol/L, total cholesterol ≥ 6.5 mmol/L, or triglycerides ≥ 5.0 mmol/L.…”

“…Dyslipidemia was defined as the presence of at least one of the following: known dyslipidemia, use of lipid-lowering drugs, a high-density lipoprotein cholesterol ≤ 0.9 mmol/L, lowdensity lipoprotein cholesterol ≥ 5.0 mmol/L, total cholesterol ≥ 6.5 mmol/L, or triglycerides ≥ 5.0 mmol/L. The individual potency of each statin was determined according to the meta-analysis by Law et al [30,43]. Ethnicity was self-reported by the trial participants.…”

“…Despite extensive research, it is currently not possible to predict the risk for gallstones in the individual bariatric patient. Most previous studies did not identify any preoperative risk factors [2,3,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], whereas others found inconsistent associations between gender, age, ethnicity, the presence of comorbidities (such as pain syndrome, hypertension, type 2 diabetes, dyslipidemia, fatty liver disease and insulin resistance), the use of statins, or type of surgery on the one hand, and symptomatic gallstone disease or gallstone formation after bariatric surgery on the other hand [4,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Although the postoperative weight loss predisposes bariatric patients to develop gallstones, it cannot be predicted beforehand.…”

The Incidence and Risk Factors of Cholelithiasis Development After Bariatric Surgery in Saudi Arabia: A Two-Center Retrospective Cohort Study

“…Similarly, other reports found that gender was not associated with cholelithiasis after bariatric surgeries (6,10,16). However, others have shown that gender is a statistically significant risk factor for cholelithiasis development (8,17). Besides gender, age is a known risk factor; one study observed a higher mean age in patients who developed cholelithiasis (18); however, data on age and cholelithiasis development remain scarce.…”