Incidence of cholelithiasis in patients diagnosed with obesity who underwent sleeve gastrectomy vs. laparoscopic Roux-en-Y gastric bypass. A retrospective study
DOI:
https://doi.org/10.33448/rsd-v14i12.50443Keywords:
Cholelithiasis, Bariatric surgery, Weight loss, Sleeve gastrectomy, Gastric bypass.Abstract
Introduction: Cholelithiasis is a frequent metabolic complication after bariatric surgery, particularly in patients experiencing rapid weight loss and significant postoperative physiological changes. Objective: The objective of this study was to evaluate the relationship between the rate of weight loss and the development of cholelithiasis in patients undergoing bariatric surgery (gastric bypass or sleeve gastrectomy). Methods: An analytical, retrospective, and longitudinal observational study was conducted at a tertiary care hospital, including 401 adult patients who underwent bariatric surgery between January 2023 and June 2025. Clinical, anthropometric, and ultrasonographic data were analyzed at 3 and 6 months postoperatively. Weight loss rate was expressed in kg/month, and descriptive, bivariate, and adjusted logistic regression analyses were performed. Results: The incidence of cholelithiasis was similar between surgical techniques at 3 months but significantly higher in the gastric bypass group at 6 months (18.4% vs. 8.5%; p < 0.001). At 3 months, a higher rate of weight loss was independently associated with an increased risk of cholelithiasis, whereas this association was not observed at 6 months. No significant modifying effect of surgical technique was identified. Conclusion: Post-bariatric cholelithiasis was more frequent after gastric bypass; however, weight loss rate emerged as the main factor associated with gallstone formation, regardless of the surgical technique used.
References
Adams, T. D., Gress, R. E., Smith, S. C., Halverson, R. C., Simper, S. C., Rosamond, W. D., Lamonte, M. J., Stroup, A. M., & Hunt, S. C. (2007). Long-term mortality after gastric bypass surgery. The New England Journal of Medicine, 357(8), 753–761.
Anveden, Å., Sjöström, O., Peltonen, M., Jacobson, P., Carlsson, L. M. S., & Sjöström, L. (2020). Long-term incidence of gallstone disease after bariatric surgery: A report from the Swedish Obese Subjects study. Surgery for Obesity and Related Diseases, 16(8), 1066–1073.
Boerlage, T. C. C., Haal, S., de Brauw, L. M., Acherman, Y. I. Z., Bruin, S., van de Laar, A. W. J. M., et al. (2017). Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery: Study protocol for a randomized controlled trial (UPGRADE trial). BMC Gastroenterology, 17(1), 164. https://doi.org/10.1186/s12876-017-0674-x
Buchwald, H., Avidor, Y., Braunwald, E., Jensen, M. D., Pories, W., Fahrbach, K., & Schoelles, K. (2004). Bariatric surgery: A systematic review and meta-analysis. JAMA, 292(14), 1724–1737.
Buxbaum, J. L., Eloubeidi, M. A., Méndez-Sánchez, N., & Sherman, S. (2005). Gallbladder disease after bariatric surgery: Mechanisms and management. The American Journal of Gastroenterology, 100(4), 850–855.
Chaar, M. E., Lundberg, P., & Stoltzfus, J. (2018). Thirty-day outcomes of sleeve gastrectomy versus Roux-en-Y gastric bypass. Surgery for Obesity and Related Diseases, 14(5), 545–551. https://doi.org/10.1016/j.soard.2018.01.011
Chen, S., Zheng, Y., Cai, J., Wu, Y., & Chen, X. (2025). Gallstones after bariatric surgery: Mechanisms and prophylaxis. Frontiers in Surgery, 12, 1506780. https://doi.org/10.3389/fsurg.2025.1506780
Costa Neto, P. L. O. & Bekman, O. R. (2009). Análise estatística da decisão. (2ed). Editora Blucher.
Coupaye, M., Castel, B., Sami, O., Tuyeras, G., Msika, S., & Ledoux, S. (2015). Comparison of the incidence of cholelithiasis after sleeve gastrectomy and Roux-en-Y gastric bypass in obese patients: A prospective study. Surgery for Obesity and Related Diseases, 11(4), 779–784. https://doi.org/10.1016/j.soard.2014.10.015
de Barros, F., Compres Guichardo, E., Monteiro Fonseca, A. B., Halamy Pereira, L., & Reyes Encalada, D. A. (2025). Comparative analysis of the incidence of post-bariatric cholelithiasis in sleeve gastrectomy and Roux-en-Y gastric bypass. Obesity Surgery, 35(8), 3157–3163. https://doi.org/10.1007/s11695-025-08020-2
Efeito da redução de peso em pacientes submetidos à técnica do bypass gástrico em Y-de-Roux. (2019). Revista de Ciências Médicas, 28(1), 11. https://doi.org/10.24220/2318-0897v28n1a4372
Everhart, J. E. (2009). Contributions of obesity and obesity-related metabolic disorders to the increasing incidence of gallstone disease. Medical Clinics of North America, 93(4), 921–933.
Golzarand, M., Toolabi, K., Parsaei, R., & Eskandari Delfan, S. (2022). Incidence of symptomatic cholelithiasis following laparoscopic Roux-en-Y gastric bypass is comparable to laparoscopic sleeve gastrectomy: A cohort study. Digestive Diseases and Sciences, 67(8), 4188–4194. https://doi.org/10.1007/s10620-021-07306-6
Grönroos, S., Helmiö, M., Juuti, A., Tiusanen, R., Hurme, S., Löyttyniemi, E., et al. (2021). Effect of laparoscopic sleeve gastrectomy vs Roux-en-Y gastric bypass on weight loss and quality of life at 7 years: The SLEEVEPASS randomized clinical trial. JAMA Surgery, 156(2), 137–146. https://doi.org/10.1001/jamasurg.2020.5666
Guan, W., Lin, S., Shen, J., Liu, R., Yang, N., & Liang, H. (2025). Comparison of five-year physical outcomes in patients undergoing laparoscopic sleeve gastrectomy plus jejunojejunal bypass versus Roux-en-Y gastric bypass. Surgery for Obesity and Related Diseases, 21(10), 1118–1125. https://doi.org/10.1016/j.soard.2025.06.008
Guraya, S. Y., & Strate, T. (2019). Effectiveness of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy for morbid obesity in achieving weight loss outcomes. International Journal of Surgery, 70, 35–43. https://doi.org/10.1016/j.ijsu.2019.08.010
Hayoz, C., Hermann, T., Raptis, D. A., Brönnimann, A., Peterli, R., & Zuber, M. (2018). Comparison of metabolic outcomes in patients undergoing laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy: A systematic review and meta-analysis of randomised controlled trials. Swiss Medical Weekly, 148, w14633. https://doi.org/10.57187/smw.2018.14633
Li, V. K. M., Pulido, N., Martinez-Suartez, P., & Méndez-Sánchez, N. (2020). Gallstone formation and management after bariatric surgery: An updated review. Surgery for Obesity and Related Diseases, 16(7), 1008–1015.
Miller, K., Hell, E., Lang, B., & Lengauer, E. (2003). Gallstone formation prophylaxis after gastric restrictive procedures for weight loss: A randomized double-blind placebo-controlled trial. Obesity Surgery, 13(5), 748–752.
Monteiro Delgado, L., Fabretina de Souza, V., Fontel Pompeu, B., de Moraes Ogawa, T., Pereira Oliveira, H., Sacksida Valladão, V. D. C., et al. (2025). Long-term outcomes in sleeve gastrectomy versus Roux-en-Y gastric bypass: A systematic review and meta-analysis of randomized trials. Obesity Surgery, 35(8), 3246–3257. https://doi.org/10.1007/s11695-025-08044-8
Moon, R. C., Teixeira, A. F., DuCoin, C., Varnadore, S., & Jawad, M. A. (2014). Comparison of cholecystectomy cases after Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding. Surgery for Obesity and Related Diseases, 10(1), 64–68. https://doi.org/10.1016/j.soard.2013.04.019
Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. (Free ebook). Santa Maria. Editora da UFSM.
Şen, O., Çelik, A., Demirci, Ö., Kocaay, F., & Yıldız, B. D. (2018). Cholelithiasis after sleeve gastrectomy and effectiveness of ursodeoxycholic acid: A systematic review and meta-analysis. Journal of Laparoendoscopic & Advanced Surgical Techniques Part A, 28(10), 931–938.
Shiffman, M. L., Sugerman, H. J., Kellum, J. M., Brewer, W. H., & Moore, E. W. (1991). Changes in gallbladder bile composition following gallstone formation and weight reduction. Gastroenterology, 101(3), 721–726.
Shitsuka, R. et al. (2014). Matemática fundamental para a tecnologia. (2ed). Editora Érica.
Sneineh, M. A., Harel, L., Elnasasra, A., Razin, H., Rotmensh, A., Moscovici, S., & Elazary, R. (2020). Increased incidence of symptomatic cholelithiasis after bariatric Roux-en-Y gastric bypass and previous bariatric surgery: A single center experience. Obesity Surgery, 30(3), 846–850. https://doi.org/10.1007/s11695-019-04366-6
Sugerman, H. J., Brewer, W. H., Shiffman, M. L., Brolin, R. E., Fobi, M. A., Linner, J. H., & MacGregor, A. M. (1995). A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodeoxycholic acid in the prevention of gallstones after gastric-bypass-induced rapid weight loss. The American Journal of Surgery, 169(1), 91–96.
Uy, M. C., Talingdan-Te, M. C., Espinosa, W. Z., Ong, J. P., & Sandoval, M. A. (2008). Ursodeoxycholic acid in the prevention of gallstone formation after laparoscopic gastric banding: A prospective randomized trial. Surgical Endoscopy, 22(3), 848–853.
Wan, Q., Zhao, R., Chen, Y., Wang, Y., Wu, Y., & Wu, X. (2021). Comparison of the incidence of cholelithiasis after sleeve gastrectomy and Roux-en-Y gastric bypass: A meta-analysis. Surgery for Obesity and Related Diseases, 17(6), 1198–1205. https://doi.org/10.1016/j.soard.2021.02.003
Wan, Y., Wang, L., Chen, Y., Zhang, W., & Wang, Z. (2021). Incidence and risk factors for gallstone formation after bariatric surgery: A meta-analysis. Obesity Surgery, 31(10), 4464–4473.
Warschkow, R., Tarantino, I., Ukegjini, K., Beutner, U., Müller, S. A., Schmied, B. M., & Steffen, T. (2018). Gallstone disease after sleeve gastrectomy: A systematic review and meta-analysis. Journal of Laparoendoscopic & Advanced Surgical Techniques Part A, 28(10), 931–938.
Wunker, C., Kumar, S., Hallowell, P., Collings, A., Loss, L., Bansal, V., et al. (2025). Bariatric surgery and relevant comorbidities: A systematic review and meta-analysis. Surgical Endoscopy, 39(3), 1419–1448. https://doi.org/10.1007/s00464-025-11528-4
Yaghoubian, A., Tolan, A., Stabile, B. E., Kaji, A. H., Belzberg, G., Mun, E., et al. (2012). Laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy achieve comparable weight loss at 1 year. The American Surgeon, 78(12), 1325–1328.
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Copyright (c) 2025 Cindy Estephania Franco Cedeño, Jose Daniel Mera Rivas, Nathali Eureka Bencosme Veras, Luis Arsenio Medina Sabando, Carlos Adrian Bustamante García, Gabrielle Vaz de Azevedo David, Frederico Japiassu Santiago, Guilherme Lemos Cotta Pereira
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