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 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.