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Published on: February 10, 2023
Concomitant versus Delayed Cholecystectomy in Bariatric Surgery
Hatem Elgohary1, Mahmoud El Azawy1, Mohey Elbanna2
1General Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt.
Background:
Obesity and weight loss after bariatric surgery have a close association with gallbladder disease. The performance and proper timing of laparoscopic cholecystectomy (LC) with bariatric surgery remain a clinical question.
Objective:
Evaluation of the outcome of LC during bariatric surgery whether done concomitantly or delayed according to the level of intraoperative difficulty.
Methods:
The prospective study included patients with morbid obesity between December 2018 and December 2019 with preoperatively detected gallbladder stones. According to the level of difficulty, patients were allocated into 2 groups: group 1 included patients who underwent concomitant LC during bariatric surgery, and group 2 included patients who underwent delayed LC after 2 months. In group 1, patients were further divided into subgroups: LC either at the beginning (subgroup A) or after bariatric surgery (subgroup B).
Results:
Operative time in group 1 vs. 2 was 92.63 ± 28.25 vs. 68.33 ± 17.49 (p < 0.001), and in subgroup A vs. B, it was 84.19 ± 19.62 vs. 130.0 ± 31.62 (p < 0.001). One patient in each group (2.6% and 8.3%) had obstructive jaundice, p > 0.001. In group 2, 33% of asymptomatic patients became symptomatic for biliary colic p > 0.001. LC difficulty score was 2.11 ± 0.70 vs. 5.66 ± 0.98 in groups 1 and 2, respectively, p < 0.001. LC difficulty score decreased in group 2 from 5.66 ± 0.98 to 2.26 ± 0.78 after 2 months of bariatric surgery, p < 0.001.
Conclusion:
Timing for LC during bariatric surgery is challenging and should be optimized for each patient as scheduling difficult LC to be performed after 2 months may be an option.
