Predictors of gallstone formation after bariatric surgery: a multivariate analysis of risk factors comparing gastric bypass, gastric banding, and sleeve gastrectomy

• Published in: Surgical endoscopy Vol. 23; no. 7; pp. 1640 - 1644
• Main Authors: Li, Vicky Ka Ming, Pulido, Nestor, Fajnwaks, Patricio, Szomstein, Samuel, Rosenthal, Raul
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.07.2009; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adolescent; Adult; Aged; Bariatric Surgery - methods; Biological and medical sciences; Body Mass Index; Cholecystectomy; Cholelithiasis - diagnostic imaging; Cholelithiasis - epidemiology; Cholelithiasis - etiology; Cholelithiasis - prevention & control; Comorbidity; Diabetes Mellitus - epidemiology; Disease Susceptibility; Female; Follow-Up Studies; Gastrectomy - methods; Gastric Bypass - methods; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Gynecology; Hepatology; Humans; Hyperlipidemias - epidemiology; Laparoscopy; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Other diseases. Semiology; Postgastrectomy Syndromes - diagnostic imaging; Postgastrectomy Syndromes - epidemiology; Postgastrectomy Syndromes - etiology; Postgastrectomy Syndromes - prevention & control; Proctology; Recurrence; Reoperation; Risk Factors; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Ultrasonography; Weight Loss; Young Adult; Gallstones; Obesity; Gastric banding; Risk factors; Gastric bypass; Sleeve gastrectomy; Endoscopic surgery; Stomach; Nutrition disorder; Bariatric surgery; Biliary tract disease; Gastrectomy; Cholelithiasis; Medicine; Treatment; Bypass; Risk factor; Digestive diseases; Gallbladder; Predictive factor; Nutritional status; Comparative study
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-008-0204-6

Background Risk factors for gallstone formation in the general population have been well studied while those after weight reduction surgery are unknown. The aim of this study was to identify the risk factors for the development of symptomatic gallstones after bariatric surgery. Method Retrospective review was performed for patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGBP), adjustable gastric banding (LAGB) or sleeve gastrectomy (LSG) between 2004 and 2006. Statistical evaluation was performed using a univariate and multivariate analysis. Risk factors, including age, gender, preoperative body mass index (BMI), BMI > 45 kg/m 2 , diabetes mellitus, hyperlipidemia, types of operation, and weight loss >25% of original weight, were analyzed for their association with postoperative symptomatic gallstones formation. Results 670 laparoscopic RYGBP, 47 LAGB, and 79 LSG were performed in our institute. Preoperative gallbladder disease, as indicated by presence of gallstones or sludge on preoperative transabdominal ultrasound, or previous cholecystectomy, were found in 25.3, 14.9, and 30.4% of patients who subsequently had RYGBP, LAGB, and LSG, respectively. A total of 586 patients were included for analysis. Mean follow-up was 25.9 (range 12–42) months. Overall rate of symptomatic gallstone formation was 7.8% and mean time for its development was 10.2 (range 2–37) months. Incidence of symptomatic gallstones with complications as initial presentation was found in 1.9% of the patients. Logistic regression analysis showed that only postoperative weight loss of more than 25% of original weight was associated with symptomatic gallstones formation [ B  = 1.482, SE = 0.533, odds ratio 4.44, 95% confidence interval (CI) 1.549–12.498, p  = 0.005]. Conclusions Traditional risk factors for gallstone formation in the general population are not predictive of symptomatic gallstone formation after bariatric surgery. Weight loss of more than 25% of original weight was the only postoperative factor that can help selecting patients for postoperative ultrasound surveillance and subsequent cholecystectomy once gallstones were identified.