Highlights
- •A cross-sectional cohort study of 1056 reproductive-aged women who underwent sleeve gastrectomy.
- •Cholecystectomy was performed in 18.8% of those who conceived vs. 10.0% of those who did not (HR [95% CI]: 3.82 (2.47, 5.92), P<0.0001).
- •Lower gestational weight gain was associated with cholecystectomy following surgery.
Abstract
Background
Reproductive-aged women constitute a substantial proportion of patients who undergo
weight loss procedures. While the risk of gallstone disease after such procedures
has been addressed extensively, the impact of pregnancy on gallstone disease after
bariatric procedures has not been reported.
Objectives
To explore the effects of pregnancy on cholecystectomy rates after laparoscopic sleeve
gastrectomy (LSG).
Setting
A university hospital.
Methods
A cross-sectional cohort study of reproductive aged women (18–45 yr) who underwent
LSG. The association between pregnancy and cholecystectomy was evaluated with Cox
regression analysis.
Results
Of 1056 women of childbearing age who underwent LSG during 2006–2017, 128 (12.1%)
subsequently experienced a pregnancy. Median follow-up durations were 3.9 and 4.9
years for women who did and did not conceive, respectively (P < .001). The median time from procedure to conception was 509 (374–1031) days. Overall,
117 (11.1%) women underwent cholecystectomy after LSG. The rate of cholecystectomy
among those who conceived was higher than among those who did not (18.8% versus 10.0%,
P = .005). In an unadjusted analysis, pregnancy was associated with an increased risk
of cholecystectomy (hazard ratio [95% confidence interval]: 3.97 [2.58, 6.09], P < .0001). The association between pregnancy and cholecystectomy persisted after controlling
for confounding factors (hazard ratio [95% confidence interval]: 3.82 [2.47, 5.92],
P < .0001). Among those who experienced pregnancy, lower gestational weight gain was
the only factor found to be associated with cholecystectomy after surgery (P = .05).
Conclusions
Pregnancy is associated with a 4-fold increased risk of cholecystectomy after LSG.
Thus, the desire for future pregnancy should be considered before LSG.
Key words
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References
- Fact Sheet N311: obesity and overweight. 2013. Geneva: World Health Organization; c2019 [updated 2018 Feb 16; cited 2018 Nov 18].(Available from:)
- Bariatric surgery: a systematic review and meta-analysis.JAMA. 2004; 292: 1724-1737
- Bariatric surgery in women of reproductive age: special concerns for pregnancy.Evid Rep Technol Assess. 2008; 169: 1-51
- Sleeve gastrectomy for obesity in polycystic ovarian syndrome: weight loss and fertility outcomes.Surg Obes Relat Dis. 2017; 13: S15
- Effect of bariatric surgery on obesity-related infertility.Surg Obes Relat Dis. 2012; 8: 445-449
- Pregnancy following bariatric surgery-medical complications and management.Obes Surg. 2016; 26: 2523-2529
- Gallbladder disease in the morbidly obese.Am J Surg. 1985; 149: 551-557
- Cholecystectomy in morbidly obese patients.Am Surg. 1987; 53: 26-28
- Impact of rapid weight reduction on risk of cholelithiasis after bariatric surgery.Obes Surg. 2003; 13: 625-628
- Incidence of cholecystectomy after bariatric surgery.Surg Obes Relat Dis. 2018; 14: 992-996
- Cholecystectomy after gastric bypass—incidence and complications.Surg Obes Relat Dis. 2017; 13: 979-987
- Incidence, natural history, and risk factors for biliary sludge and stones during pregnancy.Hepatology. 2005; 41: 359-365
- The epidemiology of gallstone disease in Rome, Italy. Part I. Prevalence data in men. The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO).Hepatology. 1988; 8: 904-906
- The epidemiology of gallstone disease in Rome, Italy. Part II. Factors associated with the disease. The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO).Hepatology. 1988; 8: 907-913
- Cholesterol cholelithiasis in pregnant women: pathogenesis, prevention and treatment.Ann Hepatol. 2014; 13: 728-745
- Association between method of delivery and maternal rehospitalization.JAMA. 2000; 283: 2411-2416
- Prevalence and ethnic differences in gallbladder disease in the United States.Gastroenterology. 1999; 117: 632-639
- Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement.Am J Clin Nutr. 1992; 55 (615S–9S)
- Using Time dependent covariates and time dependent coefficients in the Cox model [monograph on the Internet]. Rochester: Mayo Clinic; 2015 [cited 2018 Dec 3].(Available from:)
- Analysis of time-dependent covariates in failure time data.Stat Med. 1999; 18: 2123-2134
- Understanding and avoiding immortal-time bias in gastrointestinal observational research.Am J Gastroenterol. 2015; 110: 1647-1650
- Risk factors for gallstone-related hospitalization during pregnancy and the postpartum.Am J Gastroenterol. 2006; 101: 2263-2268
- Prolonged (longer than 3 hours) laparoscopic cholecystectomy: reasons and results.Am Surg. 2011; 77: 981-984
- Cholecystectomy concomitant with laparoscopic gastric bypass: a trend analysis of the nationwide inpatient sample from 2001 to 2008.Obes Surg. 2012; 22: 220-229
- Does concomitant cholecystectomy at time of Roux-en-Y gastric bypass impact adverse operative outcomes?.Obes Surg. 2013; 23: 1718-1726
- Cost analysis and risk factors for interval cholecystectomy after bariatric surgery: a national study.Surg Obes Relat Dis. 2018; 14: 368-374
- Cholecystectomy in patients submitted to bariatric procedure: a systematic review and meta-analysis.Obes Surg. 2018; 28: 3312-3320
- Cost-effectiveness analysis of cholecystectomy during Roux-en-Y gastric bypass for morbid obesity.Surgery. 2012; 152: 363-375
- Gallstones and bariatric surgery: to treat or not to treat?.World J Surg. 2016; 40: 2904-2910
- Is routine cholecystectomy justified in severely obese patients undergoing a laparoscopic Roux-en-Y gastric bypass procedure? A comparative cohort study.Obes Surg. 2011; 21: 1870-1878
- Prophylactic cholecystectomy, a mandatory step in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass?.J Gastrointest Surg. 2011; 15: 1532-1536
- Predictors of gallstone formation after bariatric surgery: a multivariate analysis of risk factors comparing gastric bypass, gastric banding, and sleeve gastrectomy.Surg Endosc. 2009; 23: 1640-1644
Article info
Publication history
Published online: July 09, 2019
Accepted:
June 29,
2019
Received:
February 25,
2019
Identification
Copyright
© 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
