Prophylactic Cholecystectomy, a Mandatory Step in Morbidly Obese Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass?
- 306 Downloads
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.
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.
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.
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.
KeywordsLaparoscopic gastric bypass Prophylactic cholecystectomy
- 2.Overweight, obesity, and health risk. National Task Force on the prevention and treatment of obesity. Arch Intern Med 2000 160: 898–904Google Scholar
- 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
- 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
- 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