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Background <p>Metabolic bariatric surgery is an effective treatment for severe obesity, yet it may increase the risk of developing cholelithiasis. Understanding risk factors for gallstone formation is crucial to optimize postoperative care.</p> Objective <p>To compare the incidence and associated factors of post-bariatric cholelithiasis between patients undergoing sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).</p> Methods <p>A retrospective cohort study was conducted on 565 patients who underwent SG or RYGB by a single surgeon between 2021 and 2025. Patients were followed for at least 2&#xa0;years with biannual ultrasound assessments. Those with preoperative cholelithiasis or incomplete follow-up were excluded. Data on demographics, associated medical problems, weight loss, and surgical details were analyzed using chi-square and unpaired Student’s <i>t</i>-test. The Mann–Whitney test was also used because no normal distribution was found. The significance level adopted was 5% in all hypothesis tests. A logistic regression was also performed in order to identify the factors that jointly determine cholelithiasis. The values of the model coefficients and the respective Odds Ratio with a 95% confidence interval were also provided.</p> Results <p>The overall incidence of cholelithiasis was 13.8%, with a higher frequency in females (85.9%, <i>p</i> &lt; 0.0001) and with no statistical difference between both procedures (<i>p</i> = 0.1405) regarding incidence, although it is slightly higher in the RYGB group. However, mean time to diagnosis was significantly shorter in RYGB compared to SG (7.7 ± 5.8 vs. 11.5 ± 9.1&#xa0;months, <i>p</i> = 0.0211), despite no significant differences in TWL% or EWL%. There is a tendency towards a higher prevalence of cholelithiasis in women (<i>p</i> = 0.0842). There was a higher incidence of cholelithiasis in white people (55.13%; <i>p</i> &lt; 0.0001). The presence of steatosis was significantly associated with gallstone formation (<i>p</i> = 0.0265).</p> Conclusion <p>Post-bariatric cholelithiasis develops earlier after RYGB than SG. Female sex and MASLD are significant risk factors. These findings emphasize the need for targeted surveillance and consideration of prophylactic strategies in high-risk patients.</p>

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Comparative Analysis of the Incidence of Post-bariatric Cholelithiasis in Sleeve Gastrectomy and Roux-en-Y Gastric Bypass

  • 期刊论文

  • 发表日期：

    2025年7月7日

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  • Fernando de Barros,
  • Enmanuel Compres Guichardo,
  • Ana Beatriz Monteiro Fonseca,
  • Leonardo Halamy Pereira,
  • Daniel Alejandro Reyes Encalada

摘要

Background

Metabolic bariatric surgery is an effective treatment for severe obesity, yet it may increase the risk of developing cholelithiasis. Understanding risk factors for gallstone formation is crucial to optimize postoperative care.

Objective

To compare the incidence and associated factors of post-bariatric cholelithiasis between patients undergoing sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).

Methods

A retrospective cohort study was conducted on 565 patients who underwent SG or RYGB by a single surgeon between 2021 and 2025. Patients were followed for at least 2 years with biannual ultrasound assessments. Those with preoperative cholelithiasis or incomplete follow-up were excluded. Data on demographics, associated medical problems, weight loss, and surgical details were analyzed using chi-square and unpaired Student’s t-test. The Mann–Whitney test was also used because no normal distribution was found. The significance level adopted was 5% in all hypothesis tests. A logistic regression was also performed in order to identify the factors that jointly determine cholelithiasis. The values of the model coefficients and the respective Odds Ratio with a 95% confidence interval were also provided.

Results

The overall incidence of cholelithiasis was 13.8%, with a higher frequency in females (85.9%, p < 0.0001) and with no statistical difference between both procedures (p = 0.1405) regarding incidence, although it is slightly higher in the RYGB group. However, mean time to diagnosis was significantly shorter in RYGB compared to SG (7.7 ± 5.8 vs. 11.5 ± 9.1 months, p = 0.0211), despite no significant differences in TWL% or EWL%. There is a tendency towards a higher prevalence of cholelithiasis in women (p = 0.0842). There was a higher incidence of cholelithiasis in white people (55.13%; p < 0.0001). The presence of steatosis was significantly associated with gallstone formation (p = 0.0265).

Conclusion

Post-bariatric cholelithiasis develops earlier after RYGB than SG. Female sex and MASLD are significant risk factors. These findings emphasize the need for targeted surveillance and consideration of prophylactic strategies in high-risk patients.