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Concomitant laparoscopic cholecystectomy with bariatric surgery: current insights from the 2015-2021 MBSAQIP database
Armaun D Rouhi1,2, Sebastian Leon1, Claire B Rosen1
1Department of Surgery, Perelman School of Medicine, University of Pennsylvania, 4 Silverstein, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Combining bariatric surgery with laparoscopic cholecystectomy (LC) is safe, showing no increased perioperative mortality. While minor risks like superficial surgical site infections and unplanned intubation are slightly higher, these events remain rare for both sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).
Area of Science:
- Bariatric surgery outcomes
- Minimally invasive surgical procedures
- Gastrointestinal surgery complications
Background:
- Obesity and gallstones often coexist, prompting evaluation of combined bariatric surgery and cholecystectomy.
- This study investigates short-term outcomes of combining sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) with laparoscopic cholecystectomy (LC).
Purpose of the Study:
- To analyze the safety and short-term outcomes of performing bariatric surgery (SG or RYGB) with a concomitant laparoscopic cholecystectomy (LC).
- To compare outcomes between patients undergoing bariatric surgery with and without LC.
Main Methods:
- Analysis of adult patients undergoing primary SG or RYGB, with or without concomitant LC, from the 2015-2021 MBSAQIP database.
- Entropy balancing was used to adjust for baseline characteristics between groups.
- Multivariable regressions assessed the association between concomitant LC and 30-day outcomes.
Main Results:
- Concomitant LC was performed in 1.0% of SG cases and 1.6% of RYGB cases.
- SG-LC patients showed higher rates of superficial surgical site infection (SSI), unplanned intubation, and pneumonia compared to SG-only.
- RYGB-LC patients had higher rates of septic shock, reoperation, and unplanned intubation than RYGB-only, though absolute differences were small.
- Adjusted analyses confirmed increased odds of unplanned intubation and superficial SSI for both SG-LC and RYGB-LC.
- Neither SG-LC nor RYGB-LC was associated with perioperative mortality, reoperation, leakage, or gastrointestinal bleeding.
Conclusions:
- Bariatric surgery combined with laparoscopic cholecystectomy demonstrates a favorable safety profile.
- No increased risk of perioperative mortality was observed after risk adjustment in over one million patients.
- While minor complications are slightly elevated, the combined procedure is associated with rare adverse events.
