Examining Biliary Disease Rates After Sleeve Gastrectomy in Adolescents

Acute pancreatitis should be high on the differential diagnosis list when evaluating abdominal symptoms in adolescents who undergo laparoscopic sleeve gastrectomy.

While laparoscopic sleeve gastrectomy is a safe and effective option for weight loss in children and adolescents, acute pancreatitis is a significant potential complication after the procedure, according to study results published in Obesity. Overall rates of biliary disease postsurgery, however, were similar between adults and pediatric patients.

Previous studies have reported that biliary complications are a frequent postoperative occurrence in adults who undergo laparoscopic sleeve gastrectomy. Furthermore, there are also reports of acute pancreatitis after metabolic surgery, although most data exist in populations of adults. The goal of the current study was to explore the risk for obstructive biliary complications after laparoscopic sleeve gastrectomy and subsequent rapid weight loss in adolescents.

The study cohort included 309 patients (74% female; mean age, 17.0±2.4 years) who were followed after undergoing laparoscopic sleeve gastrectomy at Children’s National Hospital in Washington, DC, between January 2010 and April 2019. Compliance with follow-up protocol at 3, 6, and 12 months was 83.7%, 63.7%, and 51.0%, respectively.

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During the follow-up period, 21 patients (7%) were found to have biliary disease after laparoscopic sleeve gastrectomy, including 13 cases of acute pancreatitis and 8 cases of biliary colic. There were no differences in age, sex, preoperative and operative weight and body mass index, or weight loss measures when comparing patients with biliary disease with the remainder of the study cohort.

In patients with acute pancreatitis, gallstones were evident on ultrasound in 7 (54%) and sludge or crystals were documented in 2 (15%). Gallstones were documented on ultrasound in all patients with biliary colic. Subsequently, cholecystectomy was completed without complications in all cases, and pathologic examination revealed chronic cholecystitis in most patients.

The researchers acknowledged several study limitations, including possible selection bias because of the single-center dataset and the possibility that some patients had a subclinical course of acute pancreatitis that did not require medical attention.

“Pediatric patients present with [biliary disease] at a similar rate after [sleeve gastrectomy] compared with adults. The majority of adolescents, however, manifest with [acute pancreatitis]. Thus, pancreatitis should be high on the differential diagnosis list when evaluating post-[laparoscopic sleeve gastrectomy] abdominal symptoms,” concluded the researchers.

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Tashiro J, Thenappan AA, Nadler EP. Pattern of biliary disease following laparoscopic sleeve gastrectomy in adolescents. Obesity. 2019;27(11):1750-1753.