Background

Obesity and bariatric surgery (BS) are associated with increased risk for gallstones and concomitant laparoscopic cholecystectomy (CLC) remains a matter of debate. Several studies have cited increased operative times, post-operative complications and hospital length of stay (LOS) in CLC. We compared the post-operative outcomes of CLC with BS alone (BSA).

Methods

We performed a retrospective single institution study from 01/2014 to 7/2022 at a tertiary hospital bariatric center of excellence to analyze 30-day outcomes in patients who underwent primary BS (laparoscopic sleeve gastrectomy [GS] or Roux-en-Y gastric bypass [GB]) with CLC versus BSA. Outcomes included infectious, thrombotic, cardiopulmonary, bleeding, LOS, readmission and reintervention outcomes from the local MBSAQIP database. We performed a propensity score matching (PSM) to analyze 30-day outcomes. Conditional logistic linear regression with cluster were applied after PSM.

Results

Of the 2,375 patients having BS, 84 (3.54%) patients had CLC. Before PSM, there were less SSI and readmissions but more blood transfusions and LOS in the CLC group (SMD>0.1). PSM matched 393 BS and 81 CLC cases. Of these, no significant difference was noted in any postoperative complications between BSA versus CLC, including composite outcomes (10.18% vs. 11.11%, p=0.978), LOS (1.9±3.4 vs 3.2±10.5 days, p=0.42), or for GB vs GS (p=0.90).

Conclusions

In this study, patients undergoing primary BS with CLC , after PSM, experienced no statistical difference in 30-day outcomes, regardless of type of BS. In select patients, such as with preoperative documented gallstones, laparoscopic cholecystectomy may be appropriate to consider concomitantly with bariatric surgery