Gastric Bypass and Synchronous Cholecystectomy: Not Only Numbers

The Role of Ursodeoxycholic Acid (UDCA) in Cholelithiasis Management After One Anastomosis Gastric Bypass (OAGB) for Morbid Obesity: Results of a Monocentric Randomized Controlled Trial

INTRODUCTION

Bariatric surgery leads to rapid weight loss, a well-known risk factor for gallstone formation. Postoperative biliary complication rate requiring cholecystectomy is between 0.9 and 7.5% after laparoscopic sleeve gastrectomy and between 6 and 50% after laparoscopic gastric bypass. Several authors recommended ursodeoxycholic acid (UDCA) administration to reduce gallstone formation after diet-induced weight reduction. The aim of this randomized monocentric study is to evaluate gallstone incidence after prophylactic administration of UDCA in patients undergoing one anastomosis gastric bypass (OAGB).

METHODS

Patients undergoing OAGB were prospectively randomized into 2 groups: the UDCA group receiving oral UDCA 600 mg/days for 6 months in the immediate postoperative days, and the control group not administered with UDCA. Each group included 95 patients. Abdominal ultrasound, clinical evaluation, and quality of life scoring with Gastrointestinal Quality of Life Index (GIQLI) were performed postoperatively in all patients at 3, 6, and 12 months.

RESULTS

At 12 months of postoperative follow-up, 4 (4.2%) and 24 patients (25.2%) showed gallstones in the UDCA group and control group, respectively (p < 0.05). Among those who developed gallstones, 8 (28.6%) cases were symptomatic whereas 20 (71.4%) did not show any symptom. No statistically significant difference in GIQLI score between the two groups was found.

CONCLUSION

OAGB, as other malabsorbent procedures, appears to have higher rate of cholelithiasis than purely restrictive procedures. In our prospective randomized controlled study, a regular postoperative UDCA intake during the first 6 months seems to significantly reduce cholelithiasis incidence after OAGB, with no case of intolerance reported. Further studies are needed to assess this issue.

Are Concomitant Operations During Bariatric Surgery Safe? An Analysis of the MBSAQIP Database

INTRODUCTION

The American College of Surgeons tracks 30-day outcomes using the Metabolic and Bariatric Surgery Accreditation Quality Initiative Program (MBSAQIP) database. We examined the short-term outcomes of patients that undergo bariatric surgery concomitantly with other operations such as hernia repairs and cholecystectomy to determine the safety of this practice.

METHODS

The MBSAQIP Participant Use Data File for 2015-2017 was examined for differences in primary bariatric operations vs concomitant procedures (CP). We looked for concurrent CPT codes for laparoscopic cholecystectomy (LC) and hernia repairs (ventral, epigastric, incisional, and inguinal). p was significant at < 0.05.

RESULTS

There were 464,674 cases, of which 15,614 had CP. For both LRYGB+LC and SG+LC, there were increased operative times and length of stay. There were statistically significant higher rates of readmission, reintervention, and reoperation for SG+LC vs SG alone, as well as for LRYGB+hernia and SG+hernia. There was a higher risk of death (p < 0.001) in LRYGB+hernia patients. Also, LRYGB+hernia patients had statistically significant increases in unplanned admission to the intensive care unit and pulmonary embolus. SG+hernia patients had a higher rate of ventilation > 48 h, unplanned admission to the ICU, pulmonary embolism, deep vein thrombosis, and readmission, reintervention, and reoperation.

CONCLUSIONS

There is a statistically higher rate of complications with concomitant procedures in the MBSAQIP database. Length of stay and operative times are increased in concomitant operations as are readmissions, reinterventions, and reoperations. These findings would indicate that additional procedures at the time of bariatric surgery should be deferred if possible.

Endoscopic retrograde cholangiopancreatography in Roux-en-Y gastric bypass patients

Roux-en-Y gastric bypass surgery remains a popular surgical intervention worldwide to treat morbid obesity. It is effective and relatively safe. However, one of the results related to bariatric surgery-induced rapid weight loss is the development of biliary stones. Endoscopic removal of common bile duct stones is challenging in patients with Roux-en-Y gastric bypass reconstruction. The current review highlights the different endoscopic approaches of the biliopancreatic system to perform endoscopic retrograde cholangiopancreatography in patients with Roux-en-Y gastric bypass. A treatment algorithm is provided based on clinical indications.