Obesity Surgery

, Volume 29, Issue 2, pp 464–473 | Cite as

Bariatric Surgery Did Not Increase the Risk of Gallstone Disease in Obese Patients: a Comprehensive Cohort Study

  • Jian-Han Chen
  • Ming-Shian Tsai
  • Chung-Yen Chen
  • Hui-Ming Lee
  • Chi-Fu Cheng
  • Yu-Ting Chiu
  • Wen-Yao YinEmail author
  • Cheng-Hung LeeEmail author
Original Contributions



The aim of this study was to evaluate the influence of bariatric surgery on gallstone disease in obese patients.

Materials and Methods

This large cohort retrospective study was conducted based on the Taiwan National Health Insurance Research Database. All patients 18–55 years of age with a diagnosis code for obesity (ICD-9-CM codes 278.00–278.02 or 278.1) between 2003 and 2010 were included. Patients with a history of gallstone disease and hepatic malignancies were excluded. The patients were divided into non-surgical and bariatric surgery groups. Obesity surgery was defined by ICD-9-OP codes. We also enrolled healthy civilians as the general population. The primary end point was defined as re-hospitalization with a diagnosis of gallstone disease after the index hospitalization. All patients were followed until the end of 2013, a biliary complication occurred, or death.


Two thousand three hundred seventeen patients in the bariatric surgery group, 2331 patients in the non-surgical group, and 8162 patients in the general population were included. Compared to the non-surgery group (2.79%), bariatric surgery (2.89%) did not elevate the risk of subsequent biliary events (HR = 1.075, p = 0.679). Compared to the general population (1.15%), bariatric surgery group had a significantly higher risk (HR = 4.996, p < 0.001). In the bariatric surgery group, female gender (HR = 1.774, p = 0.032) and a restrictive procedure (HR = 1.624, p = 0.048) were risk factors for gallstone disease.


The risk for gallstone disease did not increase after bariatric surgery, although the risk was still higher than the general population. The benefit of concomitant cholecystectomy during bariatric surgery should be carefully evaluated.


Bariatric surgery Validation NHIRD Gallstone disease Acute cholecystitis Obesity 



This study is based in part on data from National Health Insurance Research Database (NHIRD), provided by the National Health Insurance Administration, Ministry of Health and Welfare and managed by the National Health Research Institutes (registered number NHIRD-103-246). The data utilized in this study cannot be made available in the manuscript, the supplemental files, or in a public repository due to the “Personal Information Protection Act” executed by Taiwan’s government, starting from 2012. Requests for data can be sent as a formal proposal to the NHIRD ( or by email to

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

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

Authors and Affiliations

  1. 1.Bariatric and Metabolic Surgery CenterE-da hospitalKaohsiungTaiwan
  2. 2.Department of General SurgeryE-da hospitalKaohsiungTaiwan
  3. 3.School of MedicineI-Shou UniversityKaohsiungTaiwan
  4. 4.Department of General SurgeryE-Da Cancer HospitalKaohsiungTaiwan
  5. 5.Department of General SurgeryBuddhist Dalin Tzu Chi HospitalChiayi CountyTaiwan
  6. 6.School of MedicineTzu Chi UniversityHualienTaiwan
  7. 7.Department of Surgery, College of MedicineTzu Chi UniversityHualienTaiwan

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