Incidence of symptomatic gallstones after bariatric operations

Incidence of gallstones in morbidly obese patients and further development of symptomatic gallstones with weight loss after bariatric operations were studied. Of the 552 patients with mean preoperative weight 210.4 per cent of ideal, jejunoileal bypass has been performed upon 63, horizontal gastric partitioning in 184 and vertical banded gastroplasty in 305. Cholecystectomy had been done previously upon 146 patients (26.4 per cent). A further 67 patients (12.1 per cent) underwent cholecystectomy at the time of bariatric surgical treatment for diagnosed gallstones. The remaining 339 patients at risk of having cholelithiasis develop after a bariatric operation have been observed for more than one to 12 years; symptomatic gallstones requiring cholecystectomy developed in 39. Of these 339 patients, 17 had the symptomatic gallstones in the first year, 17 in the second year and only five from two to 12 years postoperatively. The pathologic type of stone was cholesterol in 87 per cent and mixed in 13 per cent (the latter were patients who underwent jejunoileal bypasses). In the 339 patients, 280 had lost greater than or equal to 50 per cent and 59 had lost less than 50 per cent of excess weight; symptomatic gallstones developed in 33 of the 280 in the former group and six of the 59 in the latter (p = 0.06). Although no complications resulted, concomitant cholecystectomy was often difficult in these massively obese patients, whereas cholecystectomy after weight loss has been relatively easy. Routine cholecystectomy at the time of these operations does not appear justified.