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Open Access 10-01-2023 | Bariatric Surgery | Review Article

Risk and Prophylactic Management of Gallstone Disease in Bariatric Surgery: a Systematic Review and A Bayesian meta-analysis

Authors: Filipe Amorim-Cruz, Hugo Santos-Sousa, Miguel Ribeiro, Jorge Nogueiro, André Pereira, Fernando Resende, André Costa-Pinho, John Preto, Eduardo Lima-da-Costa, Bernardo Sousa-Pinto, C. R. I.-O. group

Published in: Journal of Gastrointestinal Surgery | Issue 2/2023

Abstract

Background

The frequency and management of gallstone disease (GD) in bariatric patients, including the role of routine prophylactic concomitant cholecystectomy (CCY), are still a matter of debate. This study aims to assess the risk of de novo GD in patients undergoing bariatric surgery (BS) and their predictive factors, as well as mortality and morbidity in prophylactic CCY compared to BS alone.

Methods

We performed a systematic review, searching PubMed, EMBASE, and Web of Science until April 2021. We performed a Bayesian meta-analysis to estimate the risk of GD development after BS and the morbidity and mortality associated with BS alone versus BS + prophylactic CCY. Sources of heterogeneity were explored by meta-regression analysis.

Results

The risk of de novo post bariatric GD was 20.7% (95% credible interval [95% CrI] = 13.0–29.7%; I² = 75.4%), and that of symptomatic GD was 8.2% ([95% CrI] = 5.9–11.1%; I² = 66.9%). Pre-operative average BMI (OR = 1.04; 95% CrI = 0.92–1.17) and female patients’ proportion (OR = 1.00; 95% CrI = 0.98–1.04) were not associated with increased risk of symptomatic GD.

BS + prophylactic CCY was associated with a 97% probability of a higher number of postoperative major complications compared to BS alone (OR = 1.74, 95% CrI = 0.97–3.55; I² = 56.5%). Mortality was not substantially different between the two approaches (OR = 0.79; 95% CrI = 0.03–3.02; I² = 20.7%).

Conclusion

The risk of de novo symptomatic GD after BS is not substantially high. Although mortality is similar between groups, odds of major postoperative complications were higher in patients submitted to BS + prophylactic CCY. It is still arguable if prophylactic CCY is a fitting approach for patients with a preoperative lithiasic gallbladder.

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Title: Risk and Prophylactic Management of Gallstone Disease in Bariatric Surgery: a Systematic Review and A Bayesian meta-analysis
Authors: Filipe Amorim-Cruz
Hugo Santos-Sousa
Miguel Ribeiro
Jorge Nogueiro
André Pereira
Fernando Resende
André Costa-Pinho
John Preto
Eduardo Lima-da-Costa
Bernardo Sousa-Pinto
C. R. I.-O. group
Publication date: 10-01-2023
Publisher: Springer US
Keywords: Bariatric Surgery
Bariatric Surgery
Cholecystectomy
Published in: Journal of Gastrointestinal Surgery / Issue 2/2023
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-022-05567-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Risk and Prophylactic Management of Gallstone Disease in Bariatric Surgery: a Systematic Review and A Bayesian meta-analysis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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