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The Effect of Cholecystectomy on Weight Loss after Metabolic Bariatric Surgery
*Juan P. Cobar , *Amir Ebadinejad , *Yin Wu , *Connie Santana , Darren Tishler , *Dale Bond , Pavlos Papasavas
Hartford Healthcare, Hartford, CT

Background The role of bile acids (BAs) as regulators of metabolic physiology and weight loss in the context of metabolic and bariatric surgery (MBS) is of considerable interest. Through the activation of cellular receptors, BAs contribute to the body’s hormonal response to meals, regulating glucose, lipids, and tissue energy expenditure. Roux-en-Y gastric bypass (RYGB) increases post-prandial plasma BA response, which may contribute to greater weight loss and metabolic improvements. Cholecystectomy (CL) is one of the most commonly performed surgeries and has been associated with loss of rhythmic secretion of bile and metabolic derangements such as non-alcoholic fatty liver disease and metabolic syndrome. In a previous study of RYGB and sleeve gastrectomy (SG) patients, only RYGB with concomitant CL had a greater 1-year BMI change compared to RYGB without CL. The effect of CL before or concomitant with MBS on weight loss at multiple time points in the first postoperative year when accounting for potential confounders is unclear and requires further investigation. Study Design We conducted a retrospective, single-center review of MBS patients from 2016 to 2023. Patients were classified according to prior history of CL and type of primary MBS; RYGB or SG. Weight loss outcomes were obtained at 30 days, 6 months, and 1 year postoperatively. Mixed models were run to analyze the effect of CL on percent total weight loss (%TWL) across three time points while controlling for age, gender, race, BMI, and presence of dyslipidemia and diabetes. Results We identified 2437 patients with MBS during the study period; mean age 43.1±11.7 years, female 81.7%, white 54.7%, black 17.6%, SG 87.4%. The mean BMI was 44.7± 7.1 kg/m2; 507 (20.8%) had diabetes, and 592 (24.3%) had dyslipidemia. A total of 541 (22.2%) patients had CL, 514 (21.1%) prior to MBS, and 27 (1.1%) concurrent with MBS. There was no significant %TWL difference at any time point for SG patients. RYGB patients with CL experienced greater %TWL at 1 year compared to those without CL (32.7% vs. 29.5%; p = 0.002). Conclusion RYGB patients with a history of or concurrent CL experience 3.2% greater TWL compared to those without CL. This study provides more robust confirmatoty evidence that CL, regardless of whether it occurs before or concurrently with RYGB, is associated with greater weight loss at 1-year post-surgery. Given the loss of rhythmic bile secretion and related metabolic derangements with CL, additional mechanistic research is needed to understand this paradoxical phenomenon.


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