Introduction
Obesity and its manifold complications continue to skyrocket across the globe, positioning bariatric surgery as a pivotal procedure for those grappling with weight-related health issues. The morbidly obese population often wrestles with gallstone disease—a condition commonly spotted during preoperative evaluations for bariatric surgery. This pivotal article centers on an expansive study published in the “Surgery for Obesity and Related Diseases” journal, which minutely dissected the outcomes of patients undergoing laparoscopic gastric bypass (LGB) and laparoscopic sleeve gastrectomy (SG) combined with cholecystectomy (LC), utilizing data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).
Study Overview
The study—conducted by Wood Stephanie G., Kumar Sandhya B., Dewey Elizabeth E., Lin Matthew Y., and Carter Jonathan T.—issued from the Department of Surgery at various reputable institutions, included a data synthesis from MBSAQIP relating to patients from centers in the United States and Canada in 2015. Focusing on LGB and SG—with and without added LC—the research included a 1:1 propensity-matched cohort for both procedures. Multivariate logistic regression defined predictors of major complications post-SG and LGB, elevating concomitant LC as a potential predictor. A separate surgical site infections (SSIs) model was also established for the SG subgroup.
Methodology
This retrospective study tapped into MBSAQIP repositories to compile data on 98,292 SG operations, of which 2,046 (2%) involved concurrent LC, and 44,427 bypass interventions with 1,426 (3%) comprising LC. The researchers integrated a propensity-matched cohort to compare groups with enhanced precision, offsetting potential confounders.
Results
The study illuminated that augmentation of LC to SG extended operative time by 27 minutes on average, although no significant impacts on duration of hospital stay, mortality, or severe complications surfaced. However, a notable rise in SSIs from 0.4% to 1% and reoperation requirement from 0.7% to 1.6% manifested in unilateral analyses. Correcting for alternative predictors, LC coinciding with SG nudged up SSI risks (odds ratio 2.5, confidence interval 1.0-5.9, P = .04).
In the bypass bracket, LC upped operative time by roughly 28 minutes and postoperative hospitalization lingered about 5 hours longer (2.4 versus 2.2 days, P = .03). Nonetheless, 30-day complications mirrored between groups, and LC did not emerge as a substantive factor for critical complications upon multivariate assessment.
Discussion: Implications and Recommendations
The findings suggest that the integration of LC in laparoscopic sleeve gastrectomy or gastric bypass does not inflate mortality or substantial complication probabilities. Although slight, a .6% upturn in SSI risk signals a need for vigilance post-SG when tackling gallstone disease with LC.
Recommendations for Clinical Practice
Surgeons undertaking laparoscopic sleeve gastrectomy or gastric bypass should consult this data to inform risk-benefit conversations with patients considering concurrent cholecystectomy. The small increase in operative time and the marginal rise in risks, particularly for SSIs post-SG, should be meticulously pondered. Nonetheless, when gallstone disease coincides with obesity, the procedure appears to be generally safe and the risks manageable.
Study Limitations and Future Research
The analysis, inherently retrospective, is bound by inherent data constraints and the potential for unobserved confounding factors. Prospective studies would add invaluable heft to these conclusions. Moreover, exploring the quality-of-life outcomes for patients could provide a more holistic picture of the implications of simultaneous LC during bariatric procedures.
Conclusion
Wood et al.’s thorough MBSAQIP-based investigation reaches a resolute conclusion: Cholecystectomy, when performed with laparoscopic sleeve gastrectomy or gastric bypass, is safe without affecting major complication rates or mortality. While the incidence of SSIs post-SG demands attention, indications for simultaneous LC for gallstone disease remain justified.
DOI and References
DOI: 10.1016/j.soard.2019.03.004
Wood SG, Kumar SB, Dewey EE, Lin MY, Carter JT. Safety of concomitant cholecystectomy with laparoscopic sleeve gastrectomy and gastric bypass: a MBSAQIP analysis. Surg Obes Relat Dis. 2019;15(6):864-870.
References
1. Buchwald H. The evolution of metabolic/bariatric surgery. Obes Surg. 2014;24(8):1126-1135. doi: 10.1007/s11695-014-1292-x.
2. Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822-1832. doi: 10.1007/s11695-015-1657-z.
3. Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310(22):2416-2425. doi: 10.1001/jama.2013.280928.
4. Parikh M, Issa R, McCrillis A, Saunders JK, Ude-Welcome A, Gagner M. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg. 2013;257(2):231-237. doi: 10.1097/SLA.0b013e31826cc94d.
5. Stefanidis D, Malireddy K, Kuwada T, Phillips R, Zoog E, Gersin KS. Revisional bariatric surgery: perioperative morbidity is determined by type of procedure. Surg Obes Relat Dis. 2013;9(3):397-402. doi: 10.1016/j.soard.2012.07.012.
Keywords
1. Bariatric Surgery Complications
2. Laparoscopic Cholecystectomy
3. Gastric Bypass Safety
4. Sleeve Gastrectomy Outcomes
5. Gallstones and Obesity Treatment