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Cholecystectomy after gastric bypass-incidence and complications
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0001-9521-1203
Department of Surgical Gastroenterology, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
Department of Surgery, Mora Hospital, Mora, Sweden.
Department of Surgical and Perioperative Sciences, Division of Surgery, Sunderby Hospital, Umeå University, Umeå, Sweden.
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2017 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 13, no 6, p. 979-987Article in journal (Refereed) Published
Abstract [en]

Background: Although cholecystectomy incidence is known to be high after Roux-en-Y gastric bypass (RYGB) surgery, the actual increase in incidence is not known. Furthermore, the outcome of cholecystectomy after RYGB is not known.

Objectives: To estimate cholecystectomy incidence before and after RYGB and to compare the outcome of post-RYGB cholecystectomy with the cholecystectomy outcome in the background population.

Setting: Nationwide Swedish multiregister study.

Methods: The Swedish Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (n = 79,386) and the Scandinavian Obesity Surgery Registry (n = 36,098) were cross-matched for the years 2007 through 2013 and compared with the National Patient Register.

Results: The standardized incidence ratio for cholecystectomy before RYGB was 3.42 (2.75-4.26, P < .001); the ratio peaked at 11.4 (10.2-12.6, P < .001) 6-12 months after RYGB, which was 3.54 times the baseline level (2.78-4.49, P < .001). After 36 months, the incidence ratio had returned to baseline. The post-RYGB group demonstrated an increased risk of 30-day postoperative complications after cholecystectomy (odds ratio 2.13, 1.78-2.56; P < .001), including reoperation (odds ratio 3.84, 2.76-5.36; P < .001), compared with the background population. The post-RYGB group also demonstrated a higher risk of conversion, acute cholecystectomy, and complicated gallstone disease and a slightly prolonged operative time, adjusted for age, sex, American Society of Anesthesiologists class, and previous open RYGB.

Conclusion: Compared with the background population, the incidence of cholecystectomy was substantially elevated already before RYGB and increased further 6-36 months after RYGB. Previous RYGB doubled the risk of postoperative complications after cholecystectomy and almost quadrupled the risk of reoperation, even when intraoperative cholangiography was normal. (C) 2017 American Society for Metabolic and Bariatric Surgery.

Place, publisher, year, edition, pages
New York: Elsevier, 2017. Vol. 13, no 6, p. 979-987
Keywords [en]
Obesity, Gallstone, Cholecystectomy, Gastric bypass, Bariatric surgery
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-59318DOI: 10.1016/j.soard.2016.12.004ISI: 000406080500014PubMedID: 28185764Scopus ID: 2-s2.0-85011573631OAI: oai:DiVA.org:oru-59318DiVA, id: diva2:1136041
Note

Funding Agencies:

Örebro University Research Committee  OLL-488991 

Olle Engqvist Research Foundation 

Available from: 2017-08-25 Created: 2017-08-25 Last updated: 2017-09-08Bibliographically approved
In thesis
1. Register-based studies on cholecystectomy: Quality of life after cholecystectomy, and cholecystectomy incidence and complications after gastric bypass
Open this publication in new window or tab >>Register-based studies on cholecystectomy: Quality of life after cholecystectomy, and cholecystectomy incidence and complications after gastric bypass
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cholecystectomy (removal of the gallbladder) is standard surgical treatment for patients with symptomatic gallstone disease, albeit not without complications. Assessing the impact on quality of life is crucial for appropriate cholecystectomy patient selection, and the Gastrointestinal Quality of Life Index (GIQLI) is a 36-item questionnaire validated for this purpose.

Obesity and gastric bypass surgery each entail an increased risk of cholecystectomy, but the baseline cholecystectomy incidence in the obese population undergoing gastric bypass is unknown. Furthermore, the complication rate for cholecystectomy after gastric bypass has only been sparsely studied.

In Study I, GIQLI outcome in a post-cholecystectomy cohort of 451 patients from Mora County Hospital, Sweden, was explored. The primary cholecystectomy indication, together with sex, was found to predict gastrointestinal symptoms and abdominal pain after cholecystectomy.

In Study II, the GIQLI scores in the post-cholecystectomy cohort of Study I were compared with an age- and sex-matched control group of 390 individuals from the background population. The postcholecystectomy cohort stated significantly more gastrointestinal symptoms, especially symptoms related to bowel function such as diarrhoea, bowel urgency and bloating.

Study III was based on a cross-matching of the Swedish cholecystectomy register (GallRiks) with the Scandinavian obesity surgery register (SOReg). Previous gastric bypass doubled the postoperative complication rate after cholecystectomy and nearly quadrupled the reoperation rate. Compared with population data from the National Patient Register (NPR), the cholecystectomy incidence was substantially elevated already before gastric bypass and increased during month 6-36 thereafter.

In Study IV, the cross-matched GallRiks-SOReg database from Study III was used to compare aggregate complication rates for cholecystectomy and gastric bypass depending on the order of the two procedures. There was a significantly lower aggregate complication rate if cholecystectomy was performed before gastric bypass rather than after.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017. p. 99
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 165
Keywords
cholecystectomy, gastric bypass, bariatric, obesity, incidence, complications, register, gastrointestinal symptoms
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-59085 (URN)978-91-7529-205-2 (ISBN)
Public defence
2017-10-06, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-08-14 Created: 2017-08-14 Last updated: 2017-09-08Bibliographically approved

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