Biliary Complications of Bariatric Surgery

Obesity is a major public health problem associated with significant morbidity and mortality. Obesity is also a well-known risk factor for gallstone formation. Bariatric surgery is the most effective therapy for morbid obesity; however, the metabolic alterations it imparts can cause specific mid- or long-term complications, such as biliary lithiasis. The rate of development of cholelithiasis after bariatric surgery has been reported to be around 32% to 42% with studies ranging from 2–52% depending on use of pharmacologic prophylaxis. Therefore, prophylactic cholecystectomy during gastric bypass was historically recommended in the era of open surgery. The current management of gallbladder pathology remains a point of contention, ranging from prophylactic cholecystectomy, to cholecystectomy in the setting of biliary symptoms or presence of stones on preoperative ultrasound, to expectant management. This chapter discusses the current evidence regarding biliary complications and management in bariatric surgery.