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Concomitant cholecystectomy during laparoscopic sleeve gastrectomy

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Abstract

Background

The prevalence of cholelithiasis in morbidly obese individuals is 19–45 %. Laparoscopic sleeve gastrectomy (LSG) has become one of the most performed procedures worldwide. The management of gallstones at the time of LSG is under debate. We herein report our experience with concomitant LSG and cholecystectomy.

Methods

Patients undergoing LSG, between 2006 and 2014 with symptomatic cholelithiasis (SC), underwent concomitant cholecystectomy (SGC), and were compared to those who had LSG alone. Gender, age, and BMI were noted. Preoperative ultrasonography was performed for all patients and gallstone presence was recorded. Operative time, intraoperative mishaps, perioperative complications, length of hospital stay (LOS), and the incidence of subsequent symptomatic gallbladder disease were collected as well.

Results

SC was present in 180 patients who underwent SGC. LSG was performed in 2,383, of whom 43 (2 %) had asymptomatic cholelithiasis (AC). SGC patients had a higher percentage of females and were older (79 % and 46 years vs. 62 % and 43 years, respectively). BMI, LOS, and complications were similar. Operative time was prolonged by 35 min in SGC. Two patients with SGC had bile leakage. Of patients with AC, 9.3 % required cholecystectomy during the first post-operative year after LSG due to evolution of symptoms, compared to only 2.7 % of those with normal preoperative gallbladders. Presenting symptoms and severity of the disease were worse in the first group.

Conclusions

For SC, LSC is safe and warranted. Prophylactic cholecystectomy when gallstones are absent is unnecessary. Management of AC at the time of LSG is still debatable.

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Disclosures

Drs. A. Raziel, N. Sakran, A. Szold and D. Goitein have no conflict of interest to declare.

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Authors and Affiliations

  1. Assia Medical Group, Assuta Medical Center, Tel Aviv, Israel

    Asnat Raziel, Nasser Sakran, Amir Szold & David Goitein

  2. Department of Surgery A, Emek Medical Center, Afula, Israel

    Nasser Sakran

  3. Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    Nasser Sakran

  4. Department of Surgery C, Chaim Sheba Medical Center, 56261, Tel Hashomer, Israel

    David Goitein

  5. Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    David Goitein

Authors
  1. Asnat Raziel
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  2. Nasser Sakran
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  3. Amir Szold
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  4. David Goitein
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Correspondence to David Goitein.

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Raziel, A., Sakran, N., Szold, A. et al. Concomitant cholecystectomy during laparoscopic sleeve gastrectomy. Surg Endosc 29, 2789–2793 (2015). https://doi.org/10.1007/s00464-014-4010-z

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  • DOI: https://doi.org/10.1007/s00464-014-4010-z

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