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Potential Benefits of Prophylactic Cholecystectomy in Patients Undergoing Bariatric Bypass Surgery

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Abstract

Background

In patients with morbid obesity, laparoscopic Roux-en-Y gastric bypass (LRYGB) is the treatment of choice. Patients with gallstones routinely undergo cholecystectomy at the same time as LRYGB. Although the risk of developing gallstones afterwards is high, prophylactic cholecystectomy during LRYGB remains controversial. Therefore, we conducted a retrospective study to evaluate the risk associated with prophylactic cholecystectomy and risk factors for developing gallstones after LRYGB.

Methods

Data for patients on whom we consecutively performed LRYGB in 2003–2008 were extracted from the prospective bariatric database. The primary endpoint of the study was detection of newly developed gallstones by ultrasonography, and the secondary endpoint was evaluation of the incidence of post-LRYGB cholecystectomy (questionnaire).

Results

Of 117 patients who underwent LRYGB, 20 (17 %) had a previous and 26 (22 %) had a concomitant cholecystectomy. Of the 71 LRYGB patients remaining who had not had their gallbladders removed, 22 (34 %) developed gallstones, with 11 (17 %) requiring emergency cholecystectomy before the study began. Seven (10 %) patients were lost to follow-up, and 53 (75 %) underwent abdominal ultrasound during follow-up, which detected stones in another 11 (17 %) patients up to end of the study period.

Conclusions

Nearly 50 % of our patients had either experienced gallstones before LRYGB or developed gallstones after LRYGB. In the group with new gallstone development, 50 % required emergency cholecystectomy. These results, together with the reported better quality of life after a combined procedure and the reported economic benefits, support the use of concomitant prophylactic cholecystectomy in patients undergoing LRYGB.

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Acknowledgments

We thank Doctor Angèle Gayet-Ageron for methodological support provided by the Clinical Research Center, University of Geneva and Geneva University Hospitals. We also greatly thank Professor Henri-Marcel Hoogewoud from the Department of Radiology, Doctor Philippe Stadler from the Department of Medicine, and Doctor Nathalie Pugnale-Verillotte, the general practitioner and endocrinologist from our multidisciplinary team.

Conflict of Interest

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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    Authors and Affiliations

    1. Department of Surgery, HFR Fribourg Cantonal Hospital, 1708, Fribourg, Switzerland

      Sébastien Amstutz, Jean-Marie Michel & Bernhard Egger

    2. Department of Radiology, HFR Fribourg Cantonal Hospital, 1708, Fribourg, Switzerland

      Sébastien Kopp

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    1. Sébastien Amstutz
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    2. Jean-Marie Michel
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    Correspondence to Bernhard Egger.

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    Sébastien Amstutz and Jean-Marie Michel contributed equally to this work.

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    Amstutz, S., Michel, JM., Kopp, S. et al. Potential Benefits of Prophylactic Cholecystectomy in Patients Undergoing Bariatric Bypass Surgery. OBES SURG 25, 2054–2060 (2015). https://doi.org/10.1007/s11695-015-1650-6

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