Is Routine Cholacystectomy Required during Laparoscopic Gastric Bypass?

Leonardo Villegas, Benjamin Schneider, David Provost, Craig Chang, Daniel Scott, Thomas Sims, Lois Hill, Linda Hynan, Daniel Jones

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60 Scopus citations

Abstract

Background: Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of our study was to determine the incidence of gallstone formation requiring cholecystectomy following a laparoscopic Roux-en-Y gastric bypass (LRYGBP). Methods: 289 LRYGBP were performed between November 1999 and May 2002. 60 patients (21%) who had prior cholecystectomy were excluded. If gallstones were identified by intra-operative ultrasound (IOUS), simultaneous cholecystectomy was performed. Patients without gallstones were prescribed ursodiol for 6 months and scheduled for follow-up with transabdominal ultrasound. Results: During LRYGBP, gallstones were detected In 40 patients using IOUS (14%) and simultaneous cholecystectomy was performed. Of 189 patients with no stones identified by IOUS, 151 patients (80%) had a postoperative ultrasound after 6 months. 39 patients developed gallstones (22%) and 12 developed sludge (8%), as demonstrated by ultrasound at the time of follow-up. 11 patients had gallstone-related symptoms and subsequently underwent cholecystectomy (7%). 106 patients (70%) were gallstone-free at the time of ultrasound follow-up. Ursodiol compliance was found to be significantly lower for patients developing stones than for gallstone-free patients (38.9% vs 58.3%, z = -2.00, P = 0.045). Conclusions: There is a low incidence of symptomatic gallstones requiring cholecystectomy after LRYGBP. Prophylactic ursodlol is protective. Routine IOUS and selective cholecystectomy with close patient follow-up is a rational approach in the era of laparoscopy.

Original languageEnglish (US)
Pages (from-to)206-211
Number of pages6
JournalObesity Surgery
Volume14
Issue number2
DOIs
Publication statusPublished - Feb 2004

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Keywords

  • Bariatric surgery
  • Gastric bypass
  • Laparoscopy
  • Morbid obesity
  • Routine/selective cholecystectomy

ASJC Scopus subject areas

  • Surgery

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