Background

Biliary disease secondary to gallstone formation after rapid weight loss is well documented. Current models describe a combination of elevated cholesterol saturation in bile and decreased gallbladder contraction from reduced caloric intake, which promotes cholesterol crystallization. However, functional gallbladder disorder following sleeve gastrectomy has not been well described. We present a case series of biliary dyskinesia following laparoscopic vertical sleeve gastrectomy. ObjectivesDetermine characteristics of patients diagnosed with biliary dyskinesia following laparoscopic vertical sleeve gastrectomy. Setting:Community hospital

Methods

After Institutional Review Board approval, charts at a single institution were reviewed for patients diagnosed with biliary dyskinesia following sleeve gastrectomy from 2018-2023. Data collected include age, gender, BMI, ultrasound, cholecystokinin stimulated cholescintigraphy (HIDA-CCK), and medical comorbidities.

Results

Out of 892 patients, 5 cases were identified (0.56%). Average age was 36+-15.7 years. 80% were female. Preoperative BMI was 43.5+-7 kg/m2. Comorbidities include prediabetes (20%), hypertension (80%), dyslipidemia (20%). Primary presenting symptom was severe nausea. All cases had ejection fraction <35% on HIDA-CCK, and no cholelithiasis or sonographic evidence of cholecystitis. Time between sleeve gastrectomy and cholescintigraphy was 57.6+-30.5 days. BMI at cholecystectomy was 34.3+-6.5 kg/m2. Final pathology of gallbladder demonstrated chronic cholecystitis for all cases.

Conclusions

To our knowledge, this is the first report of biliary dyskinesia following laparoscopic sleeve gastrectomy. Pathophysiology of functional gallbladder disease after surgery is likely similar to gallstone formation. Because these patients have higher incidence of biliary dyskinesia compared to the general population, surgeons should consider this in their differential when managing severe postop nausea.