Symptomatic Biliary Lithiasis After Bariatric Surgery

Patients undergoing bariatric surgery are at high risk for both the prevalence of preoperative cholelithiasis as well as their postoperative development. The question of whether cholecystectomy should be performed during bariatric surgery remains controversial. The aim of this work is to study the results of the supra-selective approach for gallbladder management, involving concomitant cholecystectomy only in patients with gallstones-related symptoms. This is a retrospective review of a prospective database of all patients who underwent laparoscopic or robotic bariatric surgery between 2010 and 2018 in a single institution. Five hundred twenty patients were included with a median follow-up of 37.5 months. The procedure was Gastric Bypass in 328 patients (63.1%) and sleeve gastrectomy in 192 (36.9%). Seventy-one patients had a history of cholecystectomy (13.6%). Sixty-four patients had preoperative lithiasis (14.2%). Four patients underwent concomitant cholecystectomy. Fourteen (2.7%) patients required an intervention for symptomatic lithiasis: 12/445 (2.7%) patients required subsequent cholecystectomies without complication. Two patients (0.4%) required access to the biliary tree for the treatment of choledocolithiasis after RYGBP and were managed through percutaneous transhepatic approach with a success rate of 100% and no complication.The rate of symptomatic lithiasis after bariatric surgery is low. The need for a subsequent cholecystectomy in the setting of the supra-selective approach is rare, 2.7%.