Safety of concomitant cholecystectomy during one anastomosis gastric bypass compared with sleeve gastrectomy and Roux-en-Y gastric bypass

Feb 15, 2023Updates in surgery

Safety of Removing the Gallbladder During One-Anastomosis Gastric Bypass Compared to Sleeve Gastrectomy and Roux-en-Y Gastric Bypass

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Abstract

Cholecystectomy during one anastomosis gastric bypass was performed in 50 patients with no intraoperative complications.

Intraoperative complications occurred in one patient during OAGB, which was not related to cholecystectomy.
Total early-complication rates were 6% for OAGB, 2.6% for sleeve gastrectomy, and 15.4% for Roux-en-Y gastric bypass, with no significant differences.
Cholecystectomy-related complications were observed in one OAGB patient and none in sleeve gastrectomy, with a major complication for OAGB.
None of the OAGB patients required readmission, while 11.5% of Roux-en-Y gastric bypass patients did.
Previous bariatric procedures were associated with a significantly higher risk for major complications and readmissions.

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Candidates of metabolic and bariatric surgery (MBS) are prone for gallstone formation. Concomitant cholecystectomy (CC) during MBS is controversial. This study is first to examine the safety of CC during one anastomosis gastric bypass (OAGB), compared with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Single-center retrospective comparative study of CC (2012-2021) during OAGB, to SG and RYGB. CC was performed in 115 patients during OAGB (n = 50), SG (n = 39), and RYGB (n = 26). All procedures were completed laparoscopically. Baseline characteristics were similar except age, body mass index, gastroesophageal reflux disease, obstructive sleep apnea, and previous MBS (p < 0.05). Intraoperative complications occurred in one OAGB patient (2% vs. 0%, 0%; p = 0.52), which was not cholecystectomy related. There were no differences in total (6% vs. 2.6%, 15.4%; p = 0.13) and major (2% vs. 0%, 3.8; p = 0.50) early-complication rates. Of them, cholecystectomy-related complications occurred in one OAGB, compared with none of SG and one RYGB (2% vs. 0%, 3.8%; p = 0.50). The former was major, and the latter was minor complication. None of the OAGB patients needed re-admission (0% vs. 0%, 11.5; p = 0.04). All CC outcome parameters were similar between asymptomatic and symptomatic gallstones. Previous bariatric procedures were found to be a significant risk for major complications and readmissions (OR = 16.87, p = 0.019). CC during OAGB for gallstones seems safe, as in SG and RYGB. No cholecystectomy-related intraoperative complications occurred, and postoperative complication rates were low and acceptable. Outcomes for asymptomatic gallstones were similar to symptomatic ones, and we cautiously support CC in the presence of gallstones.

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Safety of concomitant cholecystectomy during one anastomosis gastric bypass compared with sleeve gastrectomy and Roux-en-Y gastric bypass

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