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Published on: February 10, 2023
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.
Background:
Obesity and cholelithiasis frequently coexist, leading to the consideration of combining bariatric surgery with laparoscopic cholecystectomy (LC) to address both conditions in a single procedure. This study analyzed short-term outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) with concomitant LC using MBSAQIP registry data.
Methods:
Adults undergoing primary SG or RYGB, with and without concomitant LC (SG-LC and SG-only or RYGB-LC and RYGB-only, respectively), were analyzed from the 2015-2021 MBSAQIP database. Differences in baseline characteristics by LC status for each bariatric procedure were adjusted using entropy balancing. Multivariable weighted logistic and linear regressions were developed to evaluate the independent association between concomitant LC and 30-day outcomes of interest.
Results:
Of 852,640 patients who underwent SG, 8705 (1.0%) received concomitant LC, while 5343 (1.6%) of 336,838 RYGB patients underwent concomitant LC. Compared to SG-only, SG-LC patients had significantly higher 30-day rates of superficial SSI (0.6% vs. 0.3%, p < 0.001), unplanned intubation (0.3% vs 0.1%, p = 0.001), and pneumonia (0.3% vs. 0.1%, p = 0.042). RYGB-LC patients experienced higher rates of septic shock (0.3% vs. 0.2%, p = 0.040), reoperation (3.5% vs. 2.7%, p = 0.009), and unplanned intubation (0.6% vs. 0.3%, p = 0.007) than RYGB-only. These were rare events with little absolute difference between LC and non-LC cohorts. Adjusted multivariate analyses confirmed increased odds of unplanned intubation (SG-LC: AOR 2.01, 95% CI 1.03-3.01; RYGB-LC: AOR 2.27, 95% CI 1.17-4.40) and superficial SSI (SG-LC: AOR 2.01, 95% CI 1.35-3.01; RYGB-LC: AOR 1.41, 95% CI 1.01-1.98) in both LC cohorts, as well as septic shock (AOR 2.83, 95% CI 1.46-5.48) among RYGB-LC. Neither SG-LC nor RYGB-LC demonstrated an association with perioperative mortality, reoperation, leakage, or gastrointestinal bleeding.
Conclusions:
In this 7-year registry study of over 1 million patients, bariatric surgery with concomitant LC demonstrated a favorable safety profile with no association with perioperative mortality after risk adjustment.
