The Impact of Cholecystectomy on Bile Reflux After One Anastomosis Gastric Bypass

Abstract

Background: Bile reflux (BR) is an issue after one anastomosis gastric bypass (OAGB). Cholecystectomy can increase BR in patients without a history of metabolic and bariatric surgery. We aimed to evaluate the effect of cholecystectomy on BR after OAGB.

Methods: This prospective observational study was conducted between March 2017 and December 2022 including 34 matched adult individuals with a body mass index ≥ 40 kg/m² or ≥ 35 in the presence of comorbidities and gallstone disease in preop evaluations who underwent primary OAGB including 17 patients who had undergone cholecystectomy simultaneously or after OAGB (OAGB + LC) and 17 patients without cholecystectomy (OAGB). All patients underwent evaluations for gastroesophageal reflux disease (GERD) and bile reflux (BR) using various methods including esophagogastroduodenoscopy (EGD), the GERD-Q questionnaire, and a hepatobiliary iminodiacetic acid (HIDA) scan.

Results: Thirty-four patients were included in this study. BR into the esophagus was not detected in both groups. BR to the gastric pouch was observed in 4 patients (23.5%) of the OAGB group and 6 patients (35.3%) of the OAGB + LC group (P = 0.452). BR to gastric remnant was observed in 6 patients (one and five patients in OAGB and OAGB + LC groups respectively) (P = 0.072). There was no statistically significant difference between the two groups, although it was clinically significant.

Conclusion: Cholecystectomy after OAGB is not associated with a change in the rate of BR in the gastric pouch but increases the incidence of BR into gastric remnant that may be harmful in the long term.

Keywords: Bile reflux; Cholecystectomy; HIDA scan; One anastomosis gastric bypass.