From the Guidelines
Cholecystectomy is recommended during bariatric surgery only for patients with symptomatic gallstones disease, as it can be considered safe and efficient, either before or at the time of bariatric surgery, according to the most recent guidelines 1.
Key Considerations
- The decision to perform a cholecystectomy during bariatric surgery should be individualized based on the patient's specific risk factors, surgical procedure type, and the surgeon's assessment of the additional operative time and potential complications that cholecystectomy would add to the primary bariatric procedure.
- For patients without gallstones at the time of surgery, ursodeoxycholic acid should be considered for 6 months after bariatric surgery to prevent gallstone formation during rapid weight loss, as recommended by the ERAS society 1.
- The optimal dose of ursodeoxycholic acid remains controversial, but studies suggest that 500-600 mg may be sufficient 1.
Benefits and Risks
- Cholecystectomy during bariatric surgery can prevent future gallbladder-related complications, such as gallstone formation and gallbladder inflammation.
- However, cholecystectomy also adds additional operative time and potential complications to the primary bariatric procedure, which should be carefully considered by the surgeon.
- Ursodeoxycholic acid is a safe and effective medication for preventing gallstone formation during rapid weight loss, but its use should be individualized based on the patient's specific risk factors and medical history.
Recommendations
- Patients with symptomatic gallstones disease should be considered for cholecystectomy either before or at the time of bariatric surgery, as recommended by the guidelines 1.
- Patients without gallstones at the time of surgery should be prescribed ursodeoxycholic acid for 6 months after bariatric surgery to prevent gallstone formation during rapid weight loss, as recommended by the ERAS society 1.
- The decision to perform a cholecystectomy during bariatric surgery should be made on a case-by-case basis, taking into account the patient's specific risk factors, surgical procedure type, and the surgeon's assessment of the additional operative time and potential complications.
From the Research
Cholecystectomy During Bariatric Surgery
- The decision to perform a cholecystectomy during bariatric surgery is a topic of debate among surgeons, with some advocating for routine cholecystectomy and others recommending a more selective approach 2, 3, 4, 5, 6.
- Studies have shown that the risk of gallstone formation and subsequent cholecystectomy is higher in patients undergoing bariatric surgery, particularly those with rapid weight loss 4, 6.
- However, the majority of studies suggest that asymptomatic gallstones in bariatric patients can be safely managed with secondary cholecystectomy, and that routine cholecystectomy is not mandatory during bariatric surgery 2, 3, 5.
- The use of ursodiol prophylaxis has been shown to reduce the risk of subsequent cholecystectomy in some studies, but its effectiveness is still a topic of debate 2, 4.
- Factors such as excess weight loss, female gender, and rapid weight loss have been identified as risk factors for postoperative cholelithiasis and cholecystectomy 4, 6.
Recommendations
- Based on the available evidence, it appears that a selective approach to cholecystectomy during bariatric surgery is recommended, with cholecystectomy only being performed in patients with symptomatic gallstone disease 3, 5.
- Asymptomatic patients can be safely managed with secondary cholecystectomy if needed, and the use of ursodiol prophylaxis can be considered in high-risk patients 2, 4.
- Regular follow-up and ultrasound examinations are recommended to monitor for gallstone formation and cholecystectomy in bariatric patients 6.