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Risk and Prophylactic Management of Gallstone Disease in Bariatric Surgery: a Systematic Review and A Bayesian meta-analysis

BACKGROUND: The frequency and management of gallstone disease (GD) in bariatric patients, including the role of routine prophylactic concomitant cholecystectomy (CCY), are still a matter of debate. This study aims to assess the risk of de novo GD in patients undergoing bariatric surgery (BS) and the...

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Autores principales: Amorim-Cruz, Filipe, Santos-Sousa, Hugo, Ribeiro, Miguel, Nogueiro, Jorge, Pereira, André, Resende, Fernando, Costa-Pinho, André, Preto, John, Lima-da-Costa, Eduardo, Sousa-Pinto, Bernardo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9974690/
https://www.ncbi.nlm.nih.gov/pubmed/36627465
http://dx.doi.org/10.1007/s11605-022-05567-8
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author Amorim-Cruz, Filipe
Santos-Sousa, Hugo
Ribeiro, Miguel
Nogueiro, Jorge
Pereira, André
Resende, Fernando
Costa-Pinho, André
Preto, John
Lima-da-Costa, Eduardo
Sousa-Pinto, Bernardo
author_facet Amorim-Cruz, Filipe
Santos-Sousa, Hugo
Ribeiro, Miguel
Nogueiro, Jorge
Pereira, André
Resende, Fernando
Costa-Pinho, André
Preto, John
Lima-da-Costa, Eduardo
Sousa-Pinto, Bernardo
author_sort Amorim-Cruz, Filipe
collection PubMed
description BACKGROUND: The frequency and management of gallstone disease (GD) in bariatric patients, including the role of routine prophylactic concomitant cholecystectomy (CCY), are still a matter of debate. This study aims to assess the risk of de novo GD in patients undergoing bariatric surgery (BS) and their predictive factors, as well as mortality and morbidity in prophylactic CCY compared to BS alone. METHODS: We performed a systematic review, searching PubMed, EMBASE, and Web of Science until April 2021. We performed a Bayesian meta-analysis to estimate the risk of GD development after BS and the morbidity and mortality associated with BS alone versus BS + prophylactic CCY. Sources of heterogeneity were explored by meta-regression analysis. RESULTS: The risk of de novo post bariatric GD was 20.7% (95% credible interval [95% CrI] = 13.0–29.7%; I(2) = 75.4%), and that of symptomatic GD was 8.2% ([95% CrI] = 5.9–11.1%; I(2) = 66.9%). Pre-operative average BMI (OR = 1.04; 95% CrI = 0.92–1.17) and female patients’ proportion (OR = 1.00; 95% CrI = 0.98–1.04) were not associated with increased risk of symptomatic GD. BS + prophylactic CCY was associated with a 97% probability of a higher number of postoperative major complications compared to BS alone (OR = 1.74, 95% CrI = 0.97–3.55; I(2) = 56.5%). Mortality was not substantially different between the two approaches (OR = 0.79; 95% CrI = 0.03–3.02; I(2) = 20.7%). CONCLUSION: The risk of de novo symptomatic GD after BS is not substantially high. Although mortality is similar between groups, odds of major postoperative complications were higher in patients submitted to BS + prophylactic CCY. It is still arguable if prophylactic CCY is a fitting approach for patients with a preoperative lithiasic gallbladder. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11605-022-05567-8.
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spelling pubmed-99746902023-03-02 Risk and Prophylactic Management of Gallstone Disease in Bariatric Surgery: a Systematic Review and A Bayesian meta-analysis Amorim-Cruz, Filipe Santos-Sousa, Hugo Ribeiro, Miguel Nogueiro, Jorge Pereira, André Resende, Fernando Costa-Pinho, André Preto, John Lima-da-Costa, Eduardo Sousa-Pinto, Bernardo J Gastrointest Surg Review Article BACKGROUND: The frequency and management of gallstone disease (GD) in bariatric patients, including the role of routine prophylactic concomitant cholecystectomy (CCY), are still a matter of debate. This study aims to assess the risk of de novo GD in patients undergoing bariatric surgery (BS) and their predictive factors, as well as mortality and morbidity in prophylactic CCY compared to BS alone. METHODS: We performed a systematic review, searching PubMed, EMBASE, and Web of Science until April 2021. We performed a Bayesian meta-analysis to estimate the risk of GD development after BS and the morbidity and mortality associated with BS alone versus BS + prophylactic CCY. Sources of heterogeneity were explored by meta-regression analysis. RESULTS: The risk of de novo post bariatric GD was 20.7% (95% credible interval [95% CrI] = 13.0–29.7%; I(2) = 75.4%), and that of symptomatic GD was 8.2% ([95% CrI] = 5.9–11.1%; I(2) = 66.9%). Pre-operative average BMI (OR = 1.04; 95% CrI = 0.92–1.17) and female patients’ proportion (OR = 1.00; 95% CrI = 0.98–1.04) were not associated with increased risk of symptomatic GD. BS + prophylactic CCY was associated with a 97% probability of a higher number of postoperative major complications compared to BS alone (OR = 1.74, 95% CrI = 0.97–3.55; I(2) = 56.5%). Mortality was not substantially different between the two approaches (OR = 0.79; 95% CrI = 0.03–3.02; I(2) = 20.7%). CONCLUSION: The risk of de novo symptomatic GD after BS is not substantially high. Although mortality is similar between groups, odds of major postoperative complications were higher in patients submitted to BS + prophylactic CCY. It is still arguable if prophylactic CCY is a fitting approach for patients with a preoperative lithiasic gallbladder. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11605-022-05567-8. Springer US 2023-01-10 2023 /pmc/articles/PMC9974690/ /pubmed/36627465 http://dx.doi.org/10.1007/s11605-022-05567-8 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Review Article
Amorim-Cruz, Filipe
Santos-Sousa, Hugo
Ribeiro, Miguel
Nogueiro, Jorge
Pereira, André
Resende, Fernando
Costa-Pinho, André
Preto, John
Lima-da-Costa, Eduardo
Sousa-Pinto, Bernardo
Risk and Prophylactic Management of Gallstone Disease in Bariatric Surgery: a Systematic Review and A Bayesian meta-analysis
title Risk and Prophylactic Management of Gallstone Disease in Bariatric Surgery: a Systematic Review and A Bayesian meta-analysis
title_full Risk and Prophylactic Management of Gallstone Disease in Bariatric Surgery: a Systematic Review and A Bayesian meta-analysis
title_fullStr Risk and Prophylactic Management of Gallstone Disease in Bariatric Surgery: a Systematic Review and A Bayesian meta-analysis
title_full_unstemmed Risk and Prophylactic Management of Gallstone Disease in Bariatric Surgery: a Systematic Review and A Bayesian meta-analysis
title_short Risk and Prophylactic Management of Gallstone Disease in Bariatric Surgery: a Systematic Review and A Bayesian meta-analysis
title_sort risk and prophylactic management of gallstone disease in bariatric surgery: a systematic review and a bayesian meta-analysis
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9974690/
https://www.ncbi.nlm.nih.gov/pubmed/36627465
http://dx.doi.org/10.1007/s11605-022-05567-8
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