Concomitant versus Delayed Cholecystectomy in Morbidly Obese Patients with Asymptomatic Gall Stones Undergoing Laparoscopic Sleeve Gastrectomy

Background: Performing cholecystectomy concomitant to laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients with asymptomatic cholelithiasis is poorly discussed.
Objectives: We conducted the current investigation to compare concomitant to late cholecystectomy in asymptomatic gall stone patients undergoing LSG.
Patients and methods: One hundred morbid obese patients scheduled for LSG were included in this retrospective analysis. They were divided into two groups: Group 1 included patients who underwent concomitant cholecystectomy, and group 2 that included patients who omitted such a procedure. Delayed cholecystectomy was scheduled if the patient developed symptoms related to gall bladder disease. The incidence of post-operative complications and percentage of developing symptomatic cholelithiasis in group 2 were our outcomes. Results: All preoperative data were statistically comparable between the two groups. However, operative time and intraoperative blood loss were significantly increased in group 1. The incidence of total early post-operative complications also increased in the same group (14% vs 0% in the other group). In Group 1, we encountered two patients with intraperitoneal bleeding (4%) who required laparoscopic management, in addition to the other two cases with biliary leakage (4%). In group 2, 18% of patients expressed symptomatic gall stone disease before the scheduled operation, while two cases (4%) developed acute complications that required early cholecystectomy. Conclusion: Cholecystectomy is associated with an increased incidence of early post-operative complications when performed in association with LSG. However, about 25% of asymptomatic cases who omitted the concomitant procedure will develop symptoms before the scheduled cholecystectomy.