The necessity and safety of simultaneous cholecystectomy during gastric surgery for patients with asymptomatic cholelithiasis

ABSTRACTObjectives The incidence of cholelithiasis is higher among individuals who have undergone gastric surgery. The benefits of concomitant gallbladder removal in asymptomatic gallstone patients remain uncertain. The aim was to investigate the necessity and safety of simultaneous cholecystectomy in this particular patient population.Methods We performed a systematic review and meta-analysis to assess the incidence of asymptomatic cholelithiasis converting to symptomatic after gastric surgery and the complication rate associated with simultaneous cholecystectomy. PubMed, Embase, and the Cochrane Library were searched for relevant articles published until 10 March 202210 March 2022.Results Patients with asymptomatic cholelithiasis after gastric surgery were at a higher risk of developing symptomatic cholelithiasis compared to those without cholelithiasis (relative risk [RR] 2.28, 95% confidence interval [CI] 1.23–4.25) and those with unknown gallbladder conditions (RR 2.70, 95% CI 1.54–4.73). Additionally, patients who underwent simultaneous cholecystectomy did not face a higher risk of complications compared to those who only underwent gastric surgery (RR 0.86, 95% CI 0.48–1.53).Conclusions Simultaneous cholecystectomy is both necessary and safe for patients with asymptomatic cholelithiasis undergoing gastric surgery. It is crucial to assess the gallbladder’s condition before gastric surgery, and if the gallbladder status is unknown, simultaneous cholecystectomy should be avoided.KEYWORDS: Cholelithiasisasymptomaticgastric surgerycholecystectomysimultaneous Declaration of interestThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Author contributionsT Jiang and H Zhang contributed equally to this study. B Zhang and Y Yin were involved in the conception and design. X Yin and Z Cai were involved in the analysis and interpretation of the data. T Jiang and H Zhang were involved in the drafting of the paper. Z Zhao, M Mu, B Liu and C Shen revised the manuscript critically for intellectual content. All of the authors approved the final version to be published and agree to be accountable for all aspects of the work.An Abstract of this work was published in the ESMO 25th World Congress on Gastrointestinal Cancer 2023, Barcelona, Spain, 28 June − 1 July 2023 (https://doi.org/10.1016/j.annonc.2023.04.185).Supplementary materialSupplemental data for this article can be accessed online at https://doi.org/10.1080/17474124.2023.2264782Additional informationFundingThis study was partially funded by the Sichuan Provincial Health and Family Planning Commission key research project (20ZD007) for Dr. Yuan Yin.