Obesity Surgery

, Volume 28, Issue 10, pp 3312–3320 | Cite as

Cholecystectomy in Patients Submitted to Bariatric Procedure: A Systematic Review and Meta-analysis

  • Francisco TustumiEmail author
  • Wanderley M. Bernardo
  • Marco A. Santo
  • Ivan Cecconello
Review Article


Weight loss following bariatric surgery increases risk for biliary stones. This study performed a meta-analysis evaluating cholecystectomy risks in bariatric patients. A systematic review and meta-analysis were performed. We evaluated the incidence rate for biliary complications in patients followed after bariatric surgery. We compared the risks for mortality, complications, and in hospital stay among patient submitted to cholecystectomy before, concomitantly with or after bariatric surgery, as well as patients submitted to bariatric surgery and cholecystectomy, and patients submitted only to bariatric surgery in order to evaluate when to perform cholecystectomy in morbidly obese patients. The incidence rate of biliary complications was 5.54 cases/1000 patient year. The addition of cholecystectomy to bariatric surgery resulted in an increased risk for complications (RD = 0.02). The risk for complications (RD = − 0.09) and reoperation (RD = − 0.02) was lower when performed concomitantly with bariatric surgery compared to post-bariatric procedure. Prophylactic cholecystectomy may be avoided. Patients submitted to bariatric surgery have low incidence rate of biliary complications, and concomitant cholecystectomy increases the risk for postoperative complications and operative time. If cholecystectomy is not indicated, patients should be carefully followed with attention for biliary complications, once cholecystectomy performed post-bariatric surgery is at higher risk for complications and reoperations.


Meta-analysis Obesity Cholelithiasis Weight loss Bariatric surgery Gastric bypass 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval Statement

This article does not contain any studies with human participants or animals performed by any of the authors. The institutional ethics committee approved this study protocol.

Informed Consent Statement

Does not apply.


  1. 1.
    Fobi M, Lee H, Igwe D, et al. Prophylactic cholecystectomy with gastric bypass operation: incidence of gallbladder disease. Obes Surg. 2002;12(3):350–3.Google Scholar
  2. 2.
    Yang H, Petersen GM, Roth MP, et al. Risk factors for gallstone formation during rapid loss of weight. Dig Dis Sci. 1992 Jun;37(6):912–8.Google Scholar
  3. 3.
    Njeze GE. Gallstones. Niger J Surg. 2013 Jul;19(2):49–55. Review
  4. 4.
    Johnston DE, Kaplan MM. Pathogenesis and treatment of gallstones. N Engl J Med. 1993 Feb 11;328(6):412–21.CrossRefPubMedGoogle Scholar
  5. 5.
    Nagem R, Lázaro-da-Silva A. Cholecystolithiasis after gastric bypass: a clinical, biochemical, and ultrasonographic 3-year follow-up study. Obes Surg. 2012 Oct;22(10):1594–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Escalona A, Boza C, Muñoz R, et al. Routine preoperative ultrasonography and selective cholecystectomy in laparoscopic Roux-en-Y gastric bypass. Why not? Obes Surg. 2008 Jan;18(1):47–51.Google Scholar
  7. 7.
    Iglézias Brandão de Oliveira C, Adami Chaim E, da Silva BB. Impact of rapid weight reduction on risk of cholelithiasis after bariatric surgery. Obes Surg 2003 Aug;13(4):625–628.Google Scholar
  8. 8.
    Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.Google Scholar
  9. 9.
    Wells G, Shea B, O’Connell D, Robertson J, Peterson J, Welch V, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available in:
  10. 10.
    Abdallah E, Emile SH, Elfeki H, et al. Role of ursodeoxycholic acid in the prevention of gallstone formation after laparoscopic sleeve gastrectomy. Surg Today. 2017 Jul;47(7):844–50.Google Scholar
  11. 11.
    Amstutz S, Michel JM, Kopp S, et al. Potential benefits of prophylactic cholecystectomy in patients undergoing bariatric bypass surgery. Obes Surg. 2015;25(11):2054–60.Google Scholar
  12. 12.
    Bardaro SJ, Gagner M, Consten E, et al. Routine cholecystectomy during laparoscopic biliopancreatic diversion with duodenal switch is not necessary. Surg Obes Relat Dis. 2007 Sep-Oct;3(5):549–53.Google Scholar
  13. 13.
    Bastouly M, Arasaki CH, Ferreira JB, et al. Early changes in postprandial gallbladder emptying in morbidly obese patients undergoing Roux-en-Y gastric bypass: correlation with the occurrence of biliary sludge and gallstones. Obes Surg. 2009 Jan;19(1):22–8.Google Scholar
  14. 14.
    Brockmeyer JR, Grover BT, Kallies KJ, et al. Management of biliary symptoms after bariatric surgery. Am J Surg. 2015 Dec;210(6):1010–6. discussion 1016-7Google Scholar
  15. 15.
    Caruana JA, McCabe MN, Smith AD, et al. Incidence of symptomatic gallstones after gastric bypass: is prophylactic treatment really necessary? Surg Obes Relat Dis. 2005 Nov-Dec;1(6):564–7. discussion 567-8Google Scholar
  16. 16.
    Coupaye M, Castel B, Sami O, et al. Comparison of the incidence of cholelithiasis after sleeve gastrectomy and Roux-en-Y gastric bypass in obese patients: a prospective study. Surg Obes Relat Dis. 2015 Jul-Aug;11(4):779–84.Google Scholar
  17. 17.
    Coupaye M, Calabrese D, Sami O, et al. Evaluation of incidence of cholelithiasis after bariatric surgery in subjects treated or not treated with ursodeoxycholic acid. Surg Obes Relat Dis. 2017 Apr;13(4):681–5.Google Scholar
  18. 18.
    D'Hondt M, Sergeant G, Deylgat B, et al. Prophylactic cholecystectomy, a mandatory step in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass? J Gastrointest Surg. 2011 Sep;15(9):1532–6.Google Scholar
  19. 19.
    Dakour-Aridi HN, El-Rayess HM, Abou-Abbass H, et al. Safety of concomitant cholecystectomy at the time of laparoscopic sleeve gastrectomy: analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Surg Obes Relat Dis. 2017 Jun;13(6):934–41.Google Scholar
  20. 20.
    Dorman RB, Zhong W, Abraham AA, et al. Does concomitant cholecystectomy at time of Roux-en-Y gastric bypass impact adverse operative outcomes? Obes Surg. 2013 Nov;23(11):1718–26.Google Scholar
  21. 21.
    Ellner SJ, Myers TT, Piorkowski JR, et al. Routine cholecystectomy is not mandatory during morbid obesity surgery. Surg Obes Relat Dis. 2007 Jul-Aug;3(4):456–60.Google Scholar
  22. 22.
    Hamad GG, Ikramuddin S, Gourash WF, et al. Elective cholecystectomy during laparoscopic Roux-en-Y gastric bypass: is it worth the wait? Obes Surg. 2003 Feb;13(1):76–81.Google Scholar
  23. 23.
    Hasan MY, Lomanto D, Loh LL, et al. Gallstone disease after laparoscopic sleeve gastrectomy in an Asian population-what proportion of gallstones actually becomes symptomatic? Obes Surg. 2017 Sep;27(9):2419–23.Google Scholar
  24. 24.
    Juo YY, Khrucharoen U, Chen Y, et al. Cost analysis and risk factors for interval cholecystectomy after bariatric surgery: a national study. Surg Obes Relat Dis. 2018 Mar;14(3):368–74.Google Scholar
  25. 25.
    Kim JJ, Schirmer B. Safety and efficacy of simultaneous cholecystectomy at Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009 Jan-Feb;5(1):48–53.Google Scholar
  26. 26.
    Lasnibat RJP, Molina FJC, Lanzarini SE, et al. Cholelithiasis in obese patients undergoing bariatric surgery: 12-month postoperatively study and monitoring. Rev Chil Cir. 2017;69(1):49–52.Google Scholar
  27. 27.
    Li VK, Pulido N, Martinez-Suartez P, et al. Symptomatic gallstones after sleeve gastrectomy. Surg Endosc. 2009 Nov;23(11):2488–92.Google Scholar
  28. 28.
    Manatsathit W, Leelasinjaroen P, Al-Hamid H, et al. The incidence of cholelithiasis after sleeve gastrectomy and its association with weight loss: a two-centre retrospective cohort study. Int J Surg. 2016 Jun;30:13–8.Google Scholar
  29. 29.
    Miller K, Hell E, Lang B, et al. Gallstone formation prophylaxis after gastric restrictive procedures for weight loss: a randomized double-blind placebo-controlled trial. Ann Surg. 2003 Nov;238(5):697–702.Google Scholar
  30. 30.
    Mishra T, Lakshmi KK, Peddi KK. Prevalence of cholelithiasis and choledocholithiasis in morbidly obese south Indian patients and the further development of biliary calculus disease after sleeve gastrectomy, gastric bypass and mini gastric bypass. Obes Surg. 2016 Oct;26(10):2411–7.Google Scholar
  31. 31.
    Moon RC, Teixeira AF, DuCoin C, et al. Comparison of cholecystectomy cases after Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding. Surg Obes Relat Dis. 2014 Jan-Feb;10(1):64–8.Google Scholar
  32. 32.
    Myers JA, Fischer GA, Sarker S, et al. Gallbladder disease in patients undergoing laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2005 Nov-Dec;1(6):561–3.Google Scholar
  33. 33.
    Papasavas PK, Gagné DJ, Ceppa FA, et al. Routine gallbladder screening not necessary in patients undergoing laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006 Jan-Feb;2(1):41–6.Google Scholar
  34. 34.
    Papavramidis S, Deligianidis N, Papavramidis T, et al. Laparoscopic cholecystectomy after bariatric surgery. Surg Endosc. 2003 Jul;17(7):1061–4.Google Scholar
  35. 35.
    Patel KR, White SC, Tejirian T, et al. Gallbladder management during laparoscopic Roux-en-Y gastric bypass surgery: routine preoperative screening for gallstones and postoperative prophylactic medical treatment are not necessary. Am Surg. 2006 Oct;72(10):857–61.Google Scholar
  36. 36.
    Pineda O, Maydón HG, Amado M, et al. A prospective study of the conservative management of asymptomatic preoperative and postoperative gallbladder disease in bariatric surgery. Obes Surg. 2017 Jan;27(1):148–53.Google Scholar
  37. 37.
    Portenier DD, Grant JP, Blackwood HS, et al. Expectant management of the asymptomatic gallbladder at Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007 Jul-Aug;3(4):476–9.Google Scholar
  38. 38.
    Sakcak I, Avsar FM, Cosgun E, et al. Management of concurrent cholelithiasis in gastric banding for morbid obesity. Eur J Gastroenterol Hepatol. 2011 Sep;23(9):766–9.Google Scholar
  39. 39.
    Scott DJ, Villegas L, Sims TL, et al. Intraoperative ultrasound and prophylactic ursodiol for gallstone prevention following laparoscopic gastric bypass. Surg Endosc. 2003 Nov;17(11):1796–802.Google Scholar
  40. 40.
    Sioka E, Zacharoulis D, Zachari E, et al. Complicated gallstones after laparoscopic sleeve gastrectomy. J Obes. 2014;2014:468203.Google Scholar
  41. 41.
    Sucandy I, Abulfaraj M, Naglak M, et al. Risk of biliary events after selective cholecystectomy during biliopancreatic diversion with duodenal switch. Obes Surg. 2016 Mar;26(3):531–7.Google Scholar
  42. 42.
    Swartz DE, Felix EL. Elective cholecystectomy after Roux-en-Y gastric bypass: why should asymptomatic gallstones be treated differently in morbidly obese patients? Surg Obes Relat Dis. 2005 Nov-Dec;1(6):555–60.Google Scholar
  43. 43.
    Tarantino I, Warschkow R, Steffen T, et al. Is routine cholecystectomy justified in severely obese patients undergoing a laparoscopic Roux-en-Y gastric bypass procedure? A comparative cohort study. Obes Surg. 2011 Dec;21(12):1870–8.Google Scholar
  44. 44.
    Taylor J, Leitman IM, Horowitz M. Is routine cholecystectomy necessary at the time of Roux-en-Y gastric bypass? Obes Surg. 2006 Jun;16(6):759–61.Google Scholar
  45. 45.
    Tucker ON, Fajnwaks P, Szomstein S, et al. Is concomitant cholecystectomy necessary in obese patients undergoing laparoscopic gastric bypass surgery? Surg Endosc. 2008 Nov;22(11):2450–4.Google Scholar
  46. 46.
    Villegas L, Schneider B, Provost D, et al. Is routine cholecystectomy required during laparoscopic gastric bypass? Obes Surg. 2004 Feb;14(2):206–11.Google Scholar
  47. 47.
    Wanjura V, Sandblom G, Österberg J, et al. Cholecystectomy after gastric bypass-incidence and complications. Surg Obes Relat Dis. 2017 Jun;13(6):979–87.Google Scholar
  48. 48.
    Wanjura V, Szabo E, Österberg J, et al. Morbidity of cholecystectomy and gastric bypass in a national database. Br J Surg. 2018 Jan;105(1):121–7.Google Scholar
  49. 49.
    Worni M, Guller U, Shah A, et al. Cholecystectomy concomitant with laparoscopic gastric bypass: a trend analysis of the nationwide inpatient sample from 2001 to 2008. Obes Surg. 2012 Feb;22(2):220–9.Google Scholar
  50. 50.
    Worobetz LJ, Inglis FG, Shaffer EA. The effect of ursodeoxycholic acid therapy on gallstone formation in the morbidly obese during rapid weight loss. Am J Gastroenterol. 1993 Oct;88(10):1705–10.Google Scholar
  51. 51.
    Wudel Jr LJ, Wright JK, Debelak JP, et al. Prevention of gallstone formation in morbidly obese patients undergoing rapid weight loss: results of a randomized controlled pilot study. J Surg Res. 2002 Jan;102(1):50–6.Google Scholar
  52. 52.
    Sugerman HJ, Brewer WH, Shiffman ML, et al. A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypass-induced rapid weight loss. Am J Surg. 1995 Jan;169(1):91–6.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Hospital das Clínicas, Gastroenterology DepartmentUniversity of Sao PauloCerqueira CesarBrazil

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