The Effect of Cholecystectomy on Weight Loss after Metabolic Bariatric Surgery

Bile acids (BAs) play a crucial role in metabolic regulation and weight loss, especially in the context of metabolic bariatric surgery (MBS). BAs contribute to the body's hormonal response to meals, influencing glucose metabolism, lipid regulation, and energy expenditure. Changes in BA homeostasis following MBS have been associated with metabolic improvements. Conversely, cholecystectomy (CCx) disrupts the rhythmic secretion of bile and has been linked to metabolic disturbances, including non-alcoholic fatty liver disease and metabolic syndrome. The impact of CCx performed prior to or concurrently with MBS on weight loss remains unclear.

We conducted a retrospective analysis of MBS patients (2016-2023), categorizing them by CCx status and type of primary MBS. Weight loss outcomes were assessed at 30 days, 6 months, and 1 year postoperatively. Linear mixed models were used to evaluate percent total weight loss (%TWL), adjusting for age, sex, BMI, and comorbidities.

Among 2437 patients, 22.2% had a history of CCx (21.1% before MBS, 1.1% concurrent). Roux-en-Y gastric bypass (RYGB) patients with CCx achieved significantly greater %TWL (32.7% vs. 29.5%; p = 0.002) and dBMI (15.2 ± 6.7 vs. 13.1 ± 4.6, p = 0.001) at 1 year compared to those without CCx. No significant differences in %TWL or dBMI were observed in sleeve gastrectomy patients.

RYGB patients with prior or concurrent CCx experienced greater weight loss than those without CCx. Further research is needed to clarify the metabolic impact of CCx on MBS and the underlying physiological mechanisms.