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The risk factors for developing cholelithiasis after bariatric surgery

Caucasian race and female sex are risk factors for developing cholelithiasis after bariatric surgery, but surgical procedure, BMI, weight loss ratio, hypertension, diabetes mellitus, dyslipidaemia and smoking are not risk factor, according to findings by researchers from the Central South University, Changsha City, Hunan Province, China. The outcomes were reported in the paper, ‘Incidence and risk factors for cholelithiasis after bariatric surgery: a systematic review and meta-analysis’, published in Lipids in Health and Disease.

Cholelithiasis (Credit: Toubser)

Although obesity has been identified as an independent risk factor for cholelithiasis and it has been hypothesised that bariatric surgery may increase the incidence of cholelithiasis, the risk factors for cholelithiasis after bariatric surgery remain uncertain.

Therefore, the researchers undertook a systematic review and meta-analysis to explore the risk factors for post-bariatric surgery cholelithiasis and proposed suggestions for clinical decision making.


There are two possible reasons for the increasing incidence of cholelithiasis after bariatric surgery:

  • One is that rapid weight loss causes fat mobilization and then a rise in serum cholesterol and triglyceride levels.

  • Intestinal dysfunction due to bariatric surgery with decreased cholecystokinin levels could cause gallbladder contractile dysfunction.

The literature review identified 19 articles (n=20,553 patients – 5,169 male patients and 15,384 female patients) included in this study. They reported that female sex (OR = 0.62, 95% CI (0.55, 0.71), p<0.00001) and Caucasian (OR = 1.62, 95% CI (1.19, 2.19), p=0.002) were both a risk factor for cholelithiasis after bariatric surgery. However, smoking was not a risk factor for cholelithiasis after bariatric surgery (OR = 1.16, 95% CI (0.71,1.88), p=0.55).

The researchers examined two surgical procedures, RYGB and SG, and defined RYGB as exposure and SG as non-exposure. A total of 10 articles investigated whether the surgical procedure is a risk factor for cholelithiasis after bariatric surgery. The found RYGB was not a risk factor for cholelithiasis after bariatric surgery (OR = 1.23, 95% CI (0.79, 1.93), p=0.36).


In addition, both preoperative BMI (OR = 1.01, 95% CI (0.98, 1.03), p=0.69) and post-operative %TWL (OR = 1.05, 95% CI (0.95, 1.16), p=0.37), were not risk factors for cholelithiasis after bariatric surgery.

The outcomes also revealed that hypertension was neither a risk factor nor a protective factor for cholelithiasis after bariatric surgery (OR = 0.72, 95% CI (0.47, 1.10), p=0.13) and the same was found of diabetes (OR = 0.99, 95% CI (0.78, 1.25), p=0.93) and dyslipidaemia (OR = 0.91, 95% CI (0.69,1.22), p=0.54).

“This meta-analysis is the first article to systematically summarize and scientifically describe risk factors for cholelithiasis after bariatric surgery,” the authors concluded. “For women and Caucasians, applying corresponding protective treatment after bariatric surgery is of higher priority in clinical decision making, such as UCDA. Surgical procedures, rapid weight loss, postoperative underlying diseases, and poor habits in the context of the occurrence of postoperative cholelithiasis still need more research for verification. There is no need to conduct protective methods routinely for these patients based on the current research conclusion.”

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