Prophylactic Cholecystectomy, a Mandatory Step in Morbidly Obese Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass?

  • Mathieu D’Hondt
  • Gregory Sergeant
  • Bert Deylgat
  • Dirk Devriendt
  • Frank Van Rooy
  • Franky Vansteenkiste
Original Article

Abstract

Background

The aim of this study was to determine the incidence of symptomatic gallstone disease requiring cholecystectomy (CCE) after laparoscopic Roux-en-Y gastric bypass (LRYGBP) and to identify the peri-operative risk factors associated with postoperative symptomatic gallstone disease.

Methods

Between August 2003 and November 2009, 724 patients underwent LRYGBP at the Groeninge Hospital. Preoperative ultrasound was performed in 600 of 641 patients without history of CCE and 120 (20.0%) were diagnosed with cholecystolithiasis.

Result

Six hundred twenty-five patients were included, 43(6.9%) developed delayed symptoms related to biliary disease. Of these 43 patients, 39 underwent post-LRYGBP CCE. Of these 39 patients, 9 (7.5%) had a positive ultrasound prior to LRYGBP. Multivariate analysis identified weight loss at 3 months post-LRYGB of more than 50% of excess weight [HR (95% CI), 2.04 (1.04–4.28); p = 0.037) as the sole significant independent predictor of delayed symptomatic cholecystolithiasis.

Conclusions

Symptomatic gallstone disease occurred only in 6.9% of patients post-LRYGBP. Multivariate analysis identified weight loss at 3 months post-LRYGBP of more than 50% of excess weight as the sole significant independent predictor of delayed symptomatic cholecystolithiasis. Prophylactic CCE should not be recommended at the time of LRYGBP.

Keywords

Laparoscopic gastric bypass Prophylactic cholecystectomy 

References

  1. 1.
    Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH The disease burden associated with overweight and obesity. JAMA 1999; 282: 1523–1529PubMedCrossRefGoogle Scholar
  2. 2.
    Overweight, obesity, and health risk. National Task Force on the prevention and treatment of obesity. Arch Intern Med 2000 160: 898–904Google Scholar
  3. 3.
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic reviaw and meta-analysis. JAMA 2004; 292: 1724–1737PubMedCrossRefGoogle Scholar
  4. 4.
    Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ, Livingston EH, Nguyen NT, Li Z, Mojica WA, Hilton L, Rhodes S, Morton SC, Shekelle PG. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005; 142: 547–559PubMedGoogle Scholar
  5. 5.
    Carey MC. Pathogenesis of gallstones. Am J Surg. 1993; 165: 410–419.PubMedCrossRefGoogle Scholar
  6. 6.
    Schmidt JH, Hocking MP, Rout WR, Woodward ER. The case for prophylactic cholecystectomy concomitant with gastric restriction for morbid obesity. Am Surg. 1988; 54: 269–272.PubMedGoogle Scholar
  7. 7.
    Scott DJ, Villegas L, Sims TL, Hamilton EC, Provost DA, Jones DB. Intraoperative ultrasound and prophylactic ursodiol for gallstone prevention following laparoscopic gastric bypass. Surg Endosc. 2003; 17: 1796–1802.PubMedCrossRefGoogle Scholar
  8. 8.
    Amaral JF, Thompson WR. Gallbladder disease in the morbidly obese. Am J Surg. 1985; 149: 551–557.PubMedCrossRefGoogle Scholar
  9. 9.
    Shiffman ML, Sugerman HJ, Kellum JM, Brewer WH, Moore EW. Gallstone formation after rapid weight loss: a prospective study in patients undergoing gastric bypass surgery for treatment for treatment of morbid obesity. Am J gastroenterol 1991; 86: 1000–1005.PubMedGoogle Scholar
  10. 10.
    Sugerman HJ, Brewer WH, Shiffman ML, Brolin RE, Fobi MA, Linner JH, MacDonald KG, MacGregor AM, Martin LF, Oram-Smith JC. A multicenter placebo-controlled, randomized double blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric bypass-induced rapid weight loss. Am J Surg. 1995; 169: 91–97.PubMedCrossRefGoogle Scholar
  11. 11.
    Weinsier RL, Ullmann DO. Gallstone formation and weight loss. Obes Res. 1993; 1: 51–56.PubMedGoogle Scholar
  12. 12.
    Patel KR, White SC, Tejirian T, Han SH, Russell D, Vira D, Liao L, Patel KB, Gracia C, Haigh P, Dutson E, Mehran A. Gallbladder management during laparoscopic Roux–en-Y gastric bypass surgery : routine preoperatieve screening for gallstones and postoperatieve prophylactic medical treatment are not necessary. Am Surg 2006; 72: 857–861.PubMedGoogle Scholar
  13. 13.
    Wudel LJ Jr, Wrigh JK, Debelak JP, Allos TM, Shyr Y, Chapman WC. Prevention of gallstone formation in morbidly obese patients undergoing rapid weight loss: results of a randomized controlled pilot study. J Surg Res 2002; 102: 50–56.PubMedCrossRefGoogle Scholar
  14. 14.
    Tucker ON, Fajnwaks P, Szomstein S, Rosenthal RJ. Is concomitant cholecystectomy necessary in obese patients undergoing laparoscopic gastric bypass surgery? Surg Endosc 2008; 22: 2450–2454.PubMedCrossRefGoogle Scholar
  15. 15.
    Shiffman ML, Sugerman HJ, Kellum JM, Brewer WH, Moore EW. Gallstones in patients with morbid obesity. Relationship to body weight, weight loss and gallbladder bile cholesterol solubility. Int J Obes Relat Metab Disord 1993; 17: 153–158PubMedGoogle Scholar
  16. 16.
    Dittrick GW, Thompson JS, Campos D, Bremers D, Sudan D. Gallbladder pathology in morbid obesity. Obes Surg 2005; 13: 238–242CrossRefGoogle Scholar
  17. 17.
    Shiffman ML, Sugerman HJ, Kellum JM, Moore EW. Changes in gallbladder bile composition following gallstone formation and weight reduction. Gastroenterology 1992; 103: 214–221PubMedGoogle Scholar
  18. 18.
    Shiffman ML, Shamburek RD, Schwarz CC, Sugerman HJ, Kellum JM, Moore EW. Gallbladder mucin, arachidonic acid, and bile lipids in patients who develop gallstones during weight reduction. Gastroenterology 1993; 105: 1200–1208PubMedGoogle Scholar
  19. 19.
    Worobetz LJ, Inglis FG, Shaffer EA. The effect of ursodeoxycholic acid therapy on gallstone formation n the morbidly obese during rapid weight loss. Am J Gastroenterol. 1993; 88(10): 1705–1710PubMedGoogle Scholar
  20. 20.
    Fakhry SM, Herbst CA, Buckwalter JA. Cholecystectomy in morbidly obese patients. Am Surg 1987; 53: 26–28PubMedGoogle Scholar
  21. 21.
    O’Brien PE, Dixon JB. A rational approach to cholelithiasis in bariatric surgery. Arch Surg 2003; 138: 908–912PubMedCrossRefGoogle Scholar
  22. 22.
    Sakorafas GH, Millingos D, Peros G. Asymptomatic cholelithiasis: is cholecystectomy really needed? A critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy; Dig. Dis. Sci. 2007; 52: 1313–1325PubMedCrossRefGoogle Scholar
  23. 23.
    Li VK, Pulido N, Fajnwaks P, Szomstein S, Rosenthal R, Martinez-Duartez P. Predictors of gallstone formation after bariatric surgery: a multivariate analysis of risk factors comparing gastric bypass, gastric banding, and sleeve gastrectomy. Surg Endosc 2009; 23: 1640–1644PubMedCrossRefGoogle Scholar
  24. 24.
    Fobi M, Lee H, Igwe D, Felahy B, James E, Stanczyk M, Fobi N. Prophylactic cholecystectomy with gastric bypass operation: incidence of gallbladder disease. Obes Surg 2002; 12: 350–353PubMedCrossRefGoogle Scholar
  25. 25.
    Liem RK, Niloff PH. Prophylactic cholecystectomy with open gastric bypass operation. Obes Surg 2004; 14: 763–765PubMedCrossRefGoogle Scholar
  26. 26.
    Csendes A, Burdiles P, Smok G, Csendes P, Burgos A, Recio M. Histologic findings of gallbladder mucosa in 87 patients with morbid obesity without gallstones compared to 87 control subjects. J Gastrointest Surg 2003; 7: 547–551PubMedCrossRefGoogle Scholar
  27. 27.
    Caruana JA, McCabe MN, Smith AD Camara DS, Mercer MA, Gillespie JA. Incidence of symptomatic gallstones after gastric bypass: is prophylactic treatment really necessary? Surg Obes Relat Dis. 2005; 1: 564–567PubMedCrossRefGoogle Scholar
  28. 28.
    Guadalajara H, Sanz Baro R, Pascual I, Blesa I, Rotundo GS, López JM, Corripio R, Vesperinas G, Sancho LG, Montes JA. Is prophylactic cholecystectomy useful in obese patients undergoing gastric bypass? Obes Surg 2006; 16: 883–885PubMedCrossRefGoogle Scholar
  29. 29.
    Ellner SJ, Myers TT, Priorkowiski JR, Mavanur AA, Barba CA.. Routine cholecystectomy is not madatory during morbid obesity surgery. Surg Obes Relat Dis. 2007; 3: 456–460PubMedCrossRefGoogle Scholar
  30. 30.
    Portenier DD, Grant JP, Blackwood HS Pryor A, McMahon RL, DeMaria E. Expectant management of the asymptomatic gallbladder at Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007; 4: 476–479.CrossRefGoogle Scholar
  31. 31.
    Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 2004; 188: 205–211PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Mathieu D’Hondt
    • 1
  • Gregory Sergeant
    • 1
  • Bert Deylgat
    • 1
  • Dirk Devriendt
    • 1
  • Frank Van Rooy
    • 1
  • Franky Vansteenkiste
    • 1
  1. 1.Department of Digestive SurgeryGroeninge HospitalKortrijkBelgium

Personalised recommendations