Outcomes of concomitant laparoscopic sleeve gastrectomy and cholecystectomy

The development of cholelithiasis and its subsequent complications are a known risk after vertical sleeve gastrectomy (VSG) due to rapid weight loss. Although controversial, concomitant cholecystectomy (CCY) at the time of bariatric surgery has been proposed, with multiple studies investigating simultaneous CCY with Roux-en-Y gastric bypass. Despite VSG being the most commonly performed bariatric surgery in the United States (US) and globally, few studies have investigated the simultaneous VSG and CCY. Therefore, this study aimed to explore the trends of concomitant VSG and CCCY and investigate the outcomes in the US and Canada using a large database.

This was a retrospective study that used data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. The database from 2015 to 2023 was queried using appropriate Current Procedural Terminology codes to identify patients who underwent VSG. This was further stratified according to patients who underwent simultaneous CCY. The demographics and characteristics of the VSG + CCY group and the VSG alone group were obtained. Logistic regression analysis was performed for the primary outcomes of 30-day morbidity, 30-day readmission, and 30-day reoperation with CCY as an independent variable. The secondary outcomes included length of stay (LOS), mortality, and need for transfusion within 72 h postoperatively.

A total of 1,140,484 patients underwent VSG between 2015 and 2023, of whom 40,780 (3.6%) had concurrent CCY. The average ages were 44.5 years in the concurrent VSG + CCY group and 43.2 years in the VSG alone group. Simultaneous surgery was more common in female patients than in those who underwent VSG alone (83.1% vs 80.5%, respectively; P <.001). In patients who underwent VSG, concomitant CCY was not an independent risk factor for increased odds of 30-day morbidity (1.2 [95% CI, 0.99-1.46]; P =.07). However, it was an independent risk factor for increased odds of 30-day readmission (1.39 [95% CI, 1.31-1.47]; P <.05) and increased odds of undergoing reoperation within 30 days (1.63 [95% CI, 1.48-1.79]; P <.05). Patients who underwent concomitant VSG + CCY had a significantly increased rate of mortality, LOS, and transfusion need within 72 h of surgery compared with those who underwent VSG alone.

Concomitant VSG + CCY was associated with increased odds of 30-day readmission and 30-day reoperation compared with VSG alone. In addition, concomitant surgery was associated with a longer LOS, an increased rate of transfusion postoperatively, and increased mortality compared with VSG alone.