Evaluating safety and outcomes of concurrent cholecystectomy in revisional and conversion bariatric surgery: an Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program case cohort analysis of 72,189 patients.

Background: Symptomatic cholelithiasis in altered foregut anatomy can have significant clinical repercussions and modify risk-benefit calculations surrounding a concurrent cholecystectomy (CC) at time of bariatric surgery.

Objectives: To characterize trends in CC during revisional and conversion bariatric surgery and evaluate its subsequent risk profile.

Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from 2020 to 2022 was used to identify 72,189 adult laparoscopic bariatric revisions (16,335 cases, 22.6%) and conversions (55,854 cases, 77.4%) METHODS: Multivariable logistic regressions were completed to calculate odds of 30-day postoperative complications, reintervention, reoperation, and conversion to open surgery associated with CC. Sensitivity analyses identified drivers of complication rates and differences in complication risk by conversion type.

Results: Multivariable analysis showed significantly increased odds of 30-day complications (odds ratio [OR] 1.45, P = .022) in revisions and conversions with CC, but not reinterventions, readmission, or conversion to open. Cases with CC had significantly higher incidences of postoperative hemorrhage (2.37% versus 1.59%, P = .008), cardiac events (.32% versus .13%, P = .021), and acute kidney injury (.32% versus .13%, P = .024). Selecting for the most performed conversions in 2020-2022 MBSAQIP, multivariable analyses reveal significantly increased odds of 30-day serious complications in adjustable gastric band (AGB) to Roux-en-Y gastric bypass (RYGB; OR 2.62, P = .038). Odds of 30-day serious complications in other leading sleeve gastrectomy and AGB conversions did not reach statistical significance.

Conclusions: While CC significantly increases odds of 30-day complications, risks and benefits of CC at time of revisions and conversions must be weighed carefully, particularly in AGB to RYGB conversions and clinical contexts with elevated risk of bleeding, cardiac events, and renal injury.