Should concurrent prophylactic cholecystectomy be performed in laparoscopic sleeve gastrectomy?

The causes of gallstone formation include rapid gain or loss of weight. Not all gallstones become symptomatic. Concurrent cholecystectomy in sleeve gastrectomy remains controversial. This study aimed to investigate whether concurrent cholecystectomy should be performed after sleeve gastrectomy (SG). A total of 268 patients with normal preoperative gallbladder ultrasonography findings, who underwent laparoscopic SG in Ankara Numune Training and Research Hospital between 2011 and 2018, were retrospectively examined. The data collected from 40 patients with symptomatic cholelithiasis during the postoperative follow-up were analyzed. Forty patients [32(80%) female and 8 (20%) male] developed symptomatic cholelithiasis after an average of 10.65 ± 5.98 months of SG and underwent surgery. The mean age of the patients was 38 ± 11 years. The mean body mass index before SG was 48.15 ± 5.61. The mean percentage of excess weight loss was 69.85 ± 17.4 at the time the patients underwent cholecystectomy. As the percentage of excess weight loss increased, the time to the development of postoperative symptomatic cholelithiasis decreased, and this relationship was statistically significant (R = 0.435, P = 0.005). Prophylactic cholecystectomy need not be performed concurrently with SG in patients without preoperative symptomatic gallstones. The reason is that laparoscopic cholecystectomy can be safely performed in the postbariatric surgery period, and the risk of symptomatic gallstone formation depends on individual risk factors.