Concomitant versus Delayed Cholecystectomy in Bariatric Surgery.

Area of Science:

• Bariatric Surgery
• Gallbladder Disease
• Surgical Outcomes

Background:

• Obesity and subsequent weight loss after bariatric surgery are closely linked to gallbladder disease.
• The optimal timing for performing laparoscopic cholecystectomy (LC) concurrently with or after bariatric surgery is a significant clinical consideration.

Purpose of the Study:

• To evaluate the outcomes of laparoscopic cholecystectomy (LC) performed concomitantly with bariatric surgery versus those performed at a later stage.
• To assess the influence of intraoperative difficulty on the choice of LC timing in bariatric patients.

Main Methods:

• A prospective study involving morbidly obese patients with preoperatively diagnosed gallstones from December 2018 to December 2019.
• Patients were divided into two groups: Group 1 (concomitant LC during bariatric surgery) and Group 2 (delayed LC after 2 months).
• Group 1 was further stratified into subgroups based on whether LC was performed before or after the bariatric procedure.

Main Results:

• Concomitant LC (Group 1) had a longer operative time (92.6 min) compared to delayed LC (Group 2, 68.3 min) (p < 0.001).
• LC difficulty scores were significantly lower for delayed LC (2.26) compared to concomitant LC (5.66) (p < 0.001), especially when performed 2 months post-bariatric surgery.
• Delayed LC in Group 2 resulted in 33% of asymptomatic patients developing biliary colic, and similar rates of obstructive jaundice were observed in both groups.

Conclusions:

• The timing of LC relative to bariatric surgery presents challenges and requires individualized patient optimization.
• Scheduling more complex LC procedures for a delayed approach, approximately 2 months after bariatric surgery, may be a viable strategy to reduce intraoperative difficulty.