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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...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2023
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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. |
format | Online Article Text |
id | pubmed-9974690 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
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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