Is Routine Cholecystectomy Required during Laparoscopic Gastric Bypass?

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

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Background: Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of this 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-operatlve 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. 33 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 who developed 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)60-66
Number of pages7
JournalObesity Surgery
Volume14
Issue number1
DOIs
StatePublished - Jan 2004

Fingerprint

Gastric Bypass
Cholecystectomy
Gallstones
Ursodeoxycholic Acid
Morbid Obesity
Laparoscopic Cholecystectomy
Incidence
Sewage
Laparoscopy
Compliance

Keywords

  • Bariatric surgery
  • Gallstones
  • Gastric bypass
  • Laparoscopic
  • Morbid obesity
  • Routine/selective cholecystectomy
  • Ursodiol

ASJC Scopus subject areas

  • Surgery

Cite this

Is Routine Cholecystectomy Required during Laparoscopic Gastric Bypass? / Villegas, Leonardo; Schneider, Benjamin; Provost, David; Chang, Craig; Scott, Daniel; Sims, Thomas; Hill, Lois; Hynan, Linda; Jones, Daniel.

In: Obesity Surgery, Vol. 14, No. 1, 01.2004, p. 60-66.

Research output: Contribution to journalArticle

Villegas, Leonardo ; Schneider, Benjamin ; Provost, David ; Chang, Craig ; Scott, Daniel ; Sims, Thomas ; Hill, Lois ; Hynan, Linda ; Jones, Daniel. / Is Routine Cholecystectomy Required during Laparoscopic Gastric Bypass?. In: Obesity Surgery. 2004 ; Vol. 14, No. 1. pp. 60-66.
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abstract = "Background: Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of this 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-operatlve 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. 33 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 who developed 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.",
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