Gastric Bypass and Synchronous Cholecystectomy: a Matter of Numbers?

Excerpt

Bariatric surgery is dramatically increasing worldwide, with 468,609 procedures reported in 2013 by the International Federation for the Surgery of Obesity (IFSO) [1]. Incidence of cholelithiasis in the general population is around 10–15% [2]. Among obese patients, incidence of biliary lithiasis is higher, approximately 25% [2]. Obesity represents a risk factor for the development of biliary lithiasis, and BMI augmentation is related to the increase of this risk [3]. Furthermore, other factors related to morbid obesity are associated to cholelithiasis: metabolic syndrome, insulin resistance, diabetes, dyslipidemia, sedentary life, and carbohydrate-rich diet and low-fiber intake [3]. After bariatric surgery, the prevalence of biliary lithiasis at follow-up abdominal ultrasound rises to 30–53% in the different series, and it is symptomatic in 7–16% of cases [4, 5]. Reasons for increase of risk of lithiasis after bariatric surgery are the increased concentration of the cholesterol into the bile, the increase of the excretion of calcium and mucin, and the augmentation of prostaglandine and arachidonic acid into the bile [6]. The major predictive factor for lithiasis is however the postoperative weight loss, with an odds ratio of 4.4 for a weight loss >25% of total weight [6]. …