Is it Safe to Perform Concomitant Cholecystectomy in Patients With Confirmed Gallbladder Disease Undergoing Metabolic and Bariatric Surgery? An Updated Meta-Analysis.

Abstract

Introduction: Obesity is a global public health issue, and metabolic and bariatric surgery (MBS) remains most effective intervention for achieving and maintaining long-term weight loss. However, rapid weight loss following MBS increases the risk of gallstone formation. Concomitant cholecystectomy (CC) during MBS has been proposed to mitigate this risk, but recent studies present conflicting evidence regarding its safety and efficacy, leaving no clear consensus.

Methods: We conducted a meta-analysis by systematically searching MEDLINE, Cochrane Central, Embase, and ClinicalTrials.gov for studies comparing CC plus BS versus BS alone. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Statistical analyses were performed with Review Manager v5.4 and RStudio v4.3.3.

Prospero id: CRD42023480360.

Results: We included 26 studies encompassing 656,830 patients with confirmed gallstones, among whom 34,409 (5.2%) underwent CC.The mean age was 41.5 years, and 79.2% were female. Patients undergoing CC + MBS had increased postoperative bleeding (OR 1.31; 95% CI 1.06-1.62; p = 0.01), wound complications (OR 1.61; 95% CI 1.34-1.95; p < 0.01), respiratory complications (OR 1.49; 95% CI 1.13-1.95; p < 0.01), and anastomotic complications (OR 1.86; 95% CI 1.28-2.70; p < 0.01). No significant differences in operation time, rates of postoperative mortality, length of hospital stay, and vein thrombosis were found between groups.

Conclusion: CC during MBS increases operative time and postoperative complications, though only anastomotic complications are clinically significant. Therefore, CC should be reserved for high-risk or symptomatic patients and avoided in bariatric procedures involving an anastomosis due to the elevated risk of complications.