Almost Routine Prophylactic Cholecystectomy During Laparoscopic Gastric Bypass is Safe
- 316 Downloads
Morbidly obese patients are at high risk to develop gallstones, and rapid weight loss after bariatric surgery further enhances this risk. The concept of prophylactic cholecystectomy during gastric bypass has been challenged recently because the risk may be lower than reported earlier and because cholecystectomy during laparoscopic gastric bypass may be more difficult and risky.
A review of prospectively collected data on 772 patients who underwent laparoscopic primary gastric bypass between January 2000 and August 2007 was performed. The charts of patients operated before 2004 were retrospectively reviewed regarding preoperative echography and histopathological findings.
Fifty-eight (7.5%) patients had had previous cholecystectomy. In the remaining patients, echography showed gallstones or sludge in 81 (11.3%). Cholecystectomy was performed at the time of gastric bypass in 665 patients (91.7%). Gallstones were found intraoperatively in 25 patients (3.9%), for a total prevalence of gallstones of 21.2%. The age of patients with gallstones was higher than that of gallstone-free patients (43.5 vs 38.7 years, p < 0.0001). Of the removed specimens, 81.8% showed abnormal histologic findings, mainly chronic cholecystitis and cholesterolosis. Cholecystectomy was associated with no procedure-related complication, prolonged duration of surgery by a mean of 19 min (4–45), and had no effect on the duration of hospital stay. Cholecystectomy was deemed too risky in 59 patients (8.3%) who were prescribed a 6-month course of ursodeoxycolic acid.
Concomitant cholecystectomy can be performed safely in most patients during laparoscopic gastric bypass and does not prolong hospital stay. As such, it is an acceptable form of prophylaxis against stones forming during rapid weight loss. Whether it is superior to chemical prophylaxis remains to be demonstrated in a large prospective randomized study.
KeywordsMorbid obesity Gastric bypass Cholecystectomy Gallstones
- 14.Consensus development conference panel: gastrointestinal surgery for severe obesity: consensus development conference statement. Ann Intern Med. 1991;115:956–61.Google Scholar
- 15.Consensus sur le traitement de l’obésité en Suisse. Schweiz Med Wochenschr. 1999;129 Suppl 114:4–20S.Google Scholar
- 23.Shiffmann ML, Kaplan GD, Brinkman-Kaplan V, et al. Prophylaxis against gallstone formation with ursodeoxycholic acid in patients participating in a very low calorie diet program. Ann Intern Med. 1995;122:899–905.Google Scholar
- 28.Portenier DD, Grant JP, Blackwood HS, et al. Expectant management of the asmptomatic gallbladder at Roux-en-Y gastric bypass. SOARD. 2007;3:476–9.Google Scholar