Comparison of complications after cholecystectomy between bariatric and non-bariatric patients: a retrospective single center cohort study

Background The global incidence of gallstone disease is rising in parallel with increasing obesity rates. Previous studies indicate a higher complication risk for cholecystectomy performed in patients with previous bariatric surgery; however, this is debated. Objectives To compare complication rate of cholecystectomy between patients with previous bariatric surgery and nonbariatric controls. The primary objective is 30-day complication rate and secondary objectives are 30 days to 1 year complication rate and the presence of persistent or new abdominal complaints. Setting Retrospective cohort study conducted at a teaching hospital in the Netherlands, including all patients who underwent cholecystectomy between 2019 and 2022 after previous bariatric surgery, with time-matched nonbariatric cholecystectomy controls. Methods A 1:2 comparison between cholecystectomy patients with previous bariatric surgery and controls. Results The bariatric surgery cohort included 133 patients and the control cohort 259 patients. The primary outcome 30-day complications after cholecystectomy was higher among postbariatric cases compared to controls (33.1% vs 16.6%, p<0.001, chi-square test, OR 2.48 (95% CI 1.52 - 4.05)). Complications between 30-days and one year was also significantly higher among postbariatric patients (18.6% vs 6.2%, p <0.001). There was no clear difference in major complications (6.0% vs 4.6%, p=0.73). Abdominal complaints 1 year after cholecystectomy were significantly more reported in postbariatric cases compared to nonbariatric controls (32.6% vs 11.2%, p <0.001). Conclusions Complications after cholecystectomy is more frequent in patients with previous bariatric surgery compared to nonbariatric controls. However, the rate of major complications is similar.