Does pregnancy increase the risk of cholecystectomy following bariatric surgery? A cross-sectional cohort study

Background: Reproductive-aged women constitute a substantial proportion of patients who undergo weight loss procedures. While the risk of gallstone disease after such procedures has been addressed extensively, the impact of pregnancy on gallstone disease after bariatric procedures has not been reported. Objectives: To explore the effects of pregnancy on cholecystectomy rates after laparoscopic sleeve gastrectomy (LSG). Setting: A university hospital. Methods: A cross-sectional cohort study of reproductive aged women (18–45 yr) who underwent LSG. The association between pregnancy and cholecystectomy was evaluated with Cox regression analysis. Results: Of 1056 women of childbearing age who underwent LSG during 2006–2017, 128 (12.1%) subsequently experienced a pregnancy. Median follow-up durations were 3.9 and 4.9 years for women who did and did not conceive, respectively (P < .001). The median time from procedure to conception was 509 (374–1031) days. Overall, 117 (11.1%) women underwent cholecystectomy after LSG. The rate of cholecystectomy among those who conceived was higher than among those who did not (18.8% versus 10.0%, P = .005). In an unadjusted analysis, pregnancy was associated with an increased risk of cholecystectomy (hazard ratio [95% confidence interval]: 3.97 [2.58, 6.09], P < .0001). The association between pregnancy and cholecystectomy persisted after controlling for confounding factors (hazard ratio [95% confidence interval]: 3.82 [2.47, 5.92], P < .0001). Among those who experienced pregnancy, lower gestational weight gain was the only factor found to be associated with cholecystectomy after surgery (P = .05). Conclusions: Pregnancy is associated with a 4-fold increased risk of cholecystectomy after LSG. Thus, the desire for future pregnancy should be considered before LSG.