Obesity Surgery

, Volume 18, Issue 1, pp 47–51 | Cite as

Routine Preoperative Ultrasonography and Selective Cholecystectomy in Laparoscopic Roux-en-Y Gastric Bypass. Why Not?

  • Alex EscalonaEmail author
  • Camilo Boza
  • Rodrigo Muñoz
  • Gustavo Pérez
  • Sabina Rayo
  • Fernando Crovari
  • Luis Ibáñez
  • Sergio Guzmán
Research Article



Preoperative evaluation and treatment of biliary lithiasis in morbid obese patients who are candidates to bariatric surgery raise a series of questions which to date has no clear consensus. The aim of this study was to evaluate the results of routine preoperative abdominal ultrasonography and selective cholecystectomy comparing patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGBP) with and without simultaneous cholecystectomy.


The prospective database of all the patients who underwent laparoscopic RYGBP in our institution was reviewed. The demographic characteristics, comorbidities, operative time, hospital stay, and postoperative complications were analyzed.


From August 2001 to December 2006, 1,311 patients underwent laparoscopic RYGBP, 137 (10.4%) of them were excluded due to previous cholecystectomy. In 128 (10.9%) of the remaining 1,174 patients, a cholecystectomy associated to laparoscopic RYGBP was performed. The mean age was 38.5 ± 10.1 years, and 106 (82.8%) were women. The mean operative time in patients with and without simultaneous cholecystectomy was 129.8 ± 45 and 108.5 ± 43 min, respectively (p < 0.001). The hospital stay was 3.6 ± 0.8 days in patients with simultaneous cholecystectomy and 4 ± 3 days in patients without simultaneous cholecystectomy (p = 0.003). There were no deaths. Postoperative complications were observed in 9 (7%) and 73 (6.9%) patients with and without simultaneous cholecystectomy respectively (p = NS). Postoperative complications were not related to the cholecystectomy.


Cholecystectomy associated to laparoscopic RYGBP should be considered in all patients with preoperative ultrasound diagnosis of cholelithiasis.


Morbid obesity Gastric bypass Cholecystectomy Gallstones 


  1. 1.
    Maclure KM, Hayes KC, Colditz GA, Stampfer MJ, Speizer FE, Willett WC. Weight, diet, and the risk of symptomatic gallstones in middle-aged women. N Engl J Med 1989;321(9):563–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Liddle RA, Goldstein RB, Saxton J. Gallstone formation during weight-reduction dieting. Arch Intern Med 1989;149(8):1750–3.PubMedCrossRefGoogle Scholar
  3. 3.
    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 of morbid obesity. Am J Gastroenterol 1991;86(8):1000–5.PubMedGoogle Scholar
  4. 4.
    Villegas L, Schneider B, Provost D, et al. Is routine cholecystectomy required during laparoscopic gastric bypass? Obes Surg 2004;14(1):60–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Hamad GG, Ikramuddin S, Gourash WF, Schauer PR. Elective cholecystectomy during laparoscopic Roux-en-Y gastric bypass: is it worth the wait? Obes Surg 2003;13(1):76–81.PubMedCrossRefGoogle Scholar
  6. 6.
    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(11):1796–802.PubMedCrossRefGoogle Scholar
  7. 7.
    Iglezias Brandao de Oliveira C, Adami Chaim E, da Silva BB. Impact of rapid weight reduction on risk of cholelithiasis after bariatric surgery. Obes Surg 2003;13(4):625–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Jones KB Jr. Simultaneous cholecystectomy: to be or not to be. Obes Surg 1995;5(1):52–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Guadalajara H, Sanz Baro R, Pascual I, et al. Is prophylactic cholecystectomy useful in obese patients undergoing gastric bypass? Obes Surg 2006;16(7):883–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Liem RK, Niloff PH. Prophylactic cholecystectomy with open gastric bypass operation. Obes Surg 2004;14(6):763–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Fobi M, Lee H, Igwe D, et al. Prophylactic cholecystectomy with gastric bypass operation: incidence of gallbladder disease. Obes Surg 2002;12(3):350–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Nguyen NT, Goldman C, Rosenquist CJ, et al. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life, and costs. Ann Surg 2001;234(3):279–89; discussion 89–91.PubMedCrossRefGoogle Scholar
  13. 13.
    Patel KR, White SC, Tejirian T, et al. Gallbladder management during laparoscopic Roux-en-Y gastric bypass surgery: routine preoperative screening for gallstones and postoperative prophylactic medical treatment are not necessary. Am Surg 2006;72(10):857–61.PubMedGoogle Scholar
  14. 14.
    Martinez J, Guerrero L, Byers P, et al. Endoscopic retrograde cholangiopancreatography and gastroduodenoscopy after Roux-en-Y gastric bypass. Surg Endosc 2006;20(10):1548–50.PubMedCrossRefGoogle Scholar
  15. 15.
    Mosler P, Fogel EL. Massive subcutaneous emphysema after attempted endoscopic retrograde cholangiopancreatography in a patient with a history of bariatric gastric bypass surgery. Endoscopy 2007, doi:10.1055/s-2006-925181.
  16. 16.
    Carrasco F, Klaassen J, Papapietro K, et al. A proposal of guidelines for surgical management of obesity. Rev Med Chil 2005;133(6):699–706.PubMedGoogle Scholar
  17. 17.
    NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med 1991;115(12):956–61.Google Scholar
  18. 18.
    Fuller W, Rasmussen JJ, Ghosh J, Ali MR. Is routine cholecystectomy indicated for asymptomatic cholelithiasis in patients undergoing gastric bypass? Obes Surg 2007;17(6):747–51.PubMedCrossRefGoogle Scholar
  19. 19.
    Venneman NG, van Erpecum KJ. Gallstone disease: primary and secondary prevention. Best Pract Res Clin Gastroenterol 2006;20(6):1063–73.PubMedCrossRefGoogle Scholar
  20. 20.
    Lawrentschuk N, Hewitt PM, Pritchard MG. Elective laparoscopic cholecystectomy: implications of prolonged waiting times for surgery. ANZ J Surg 2003;73(11):890–3.PubMedCrossRefGoogle Scholar
  21. 21.
    Salman B, Yuksel O, Irkorucu O, et al. Urgent laparoscopic cholecystectomy is the best management for biliary colic. A prospective randomized study of 75 cases. Dig Surg 2005;22(1–2):95–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Rutledge D, Jones D, Rege R. Consequences of delay in surgical treatment of biliary disease. Am J Surg 2000;180(6):466–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Oria HE. Pitfalls in the diagnosis of gallbladder disease in clinically severe obesity. Obes Surg 1998;8(4):444–51.PubMedCrossRefGoogle Scholar
  24. 24.
    Sidhu RS, Raj PK, Treat RC, Scarcipino MA, Tarr SM. Obesity as a factor in laparoscopic cholecystectomy. Surg Endosc 2007;21(5):774–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Rosen M, Brody F, Ponsky J. Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg 2002;184(3):254–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Hutchinson CH, Traverso LW, Lee FT. Laparoscopic cholecystectomy. Do preoperative factors predict the need to convert to open? Surg Endosc 1994;8(8):875–8; discussion 9–80.PubMedCrossRefGoogle Scholar
  27. 27.
    Livingston EH, Huerta S, Arthur D, Lee S, De Shields S, Heber D. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg 2002;236(5):576–82.PubMedCrossRefGoogle Scholar
  28. 28.
    Abboud PA, Malet PF, Berlin JA, et al. Predictors of common bile duct stones prior to cholecystectomy: a meta-analysis. Gastrointest Endosc 1996;44(4):450–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Alex Escalona
    • 1
    • 2
    Email author
  • Camilo Boza
    • 1
  • Rodrigo Muñoz
    • 1
  • Gustavo Pérez
    • 1
  • Sabina Rayo
    • 1
  • Fernando Crovari
    • 1
  • Luis Ibáñez
    • 1
  • Sergio Guzmán
    • 1
  1. 1.Departamento de Cirugía Digestiva, División de Cirugía, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile
  2. 2.SantiagoChile

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