Skip to main content
SpringerLink
Log in

Is Routine Cholecystectomy Indicated for Asymptomatic Cholelithiasis in Patients Undergoing Gastric Bypass?

  • Published:
Obesity Surgery Aims and scope Submit manuscript

Background

The purpose of this study was to evaluate the natural history of patients undergoing Rouxen-Y gastric bypass (RYGBP) with known asymptomatic cholelithiasis in whom prophylactic cholecystectomy was not performed at the time of surgery.

Methods

The records of 144 consecutive patients from a single year experience in RYGBP surgery at the University of California, Davis Medical Center were reviewed. Patients undergoing RYGBP were routinely screened for cholelithiasis by ultrasound. Patients who did not have cholecystectomy were managed with ursodiol for 6 months postoperatively.

Results

13 males (9.0%) and 131 females (91%) underwent RYGBP. The mean age was 43 years (SD 8.55), and mean BMI was 46 kg/m2 (SD 6.5). The comorbidities of our patient population included diabetes (14%), hypertension (48%), gastroesophageal reflux disease (50%), dyslipidemia (35%), obstructive sleep apnea (31%), and musculoskeletal complaints (69%). 22 patients were diagnosed with cholelithiasis by ultrasonography preoperatively. 9 of these patients (41%) were symptomatic and underwent concurrent cholecystectomy and RYGBP. The remaining 13 patients (59%) had asymptomatic cholelithiasis preoperatively but did not undergo cholecystectomy at the time of surgery. Only one of these asymptomatic patients eventually developed symptoms necessitating cholecystectomy at up to 1 year follow-up.

Conclusions

Our data suggest that it may not be absolutely indicated to perform prophylactic cholecystectomy at the time of RYGBP surgery for asymptomatic cholelithiasis. We believe that this phenomenon needs to be further studied in a randomized trial.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Deitel M, Petrov I. Incidence of symptomatic gallstones after baratirc operations. Surg Gynecol Obstet 1987;164: 549–52.

    PubMed  CAS  Google Scholar 

  2. 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: 625–8.

    Article  Google Scholar 

  3. Shiffman ML, Sugerman HJ, Kellum JM et al. Gallstone formation after rapid weight loss: a prospective study of patients undergoing gastric bypass surgery for treatment of morbid obesity. Am J Gastroenterol 1991;8: 1000–5.

    Google Scholar 

  4. Friedman GD. Natural history of asymptomatic and symptomatic gallstones. Am J Surg 1993; 4: 399–404.

    Article  Google Scholar 

  5. Sugerman H, Brewere W, Shiffman M et al. A multicerter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastricbypass-induced rapid weight loss. Am J Surg 995;169: 91–7.

    Article  PubMed  CAS  Google Scholar 

  6. Worobetz LJ, Inglis FG, Shaffer EA. The effect of ursodeoxycholic acid therapy on gallstone formation in the morbidly obese during rapid weight loss. Am J Gastroenterol 1993; 10: 1705–10.

    Google Scholar 

  7. Shiffman M, Kaplan G, 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.

    PubMed  CAS  Google Scholar 

  8. Wudel L, Wright J, Debelak J et al. Prevention of gallstone formatin in morbidly obese patients undergoing rapid weight loss: results of a randomized controlled pilot study. J Surg Res 2002; 102: 50–6.

    Article  PubMed  CAS  Google Scholar 

  9. Schmidt JH, Hocking MP, Rout WR et al. The case for prophylactic cholecystectomy concomitant with gastric restriction for morbid obesity. Am Surg 1988; 54: 269–72.

    PubMed  CAS  Google Scholar 

  10. Villegas L, Schneider B, Provost D et al. Is Routine cholecystectomy required during laparoscopic gastric bypass? Obes Surg 2004; 14: 206–11.

    Article  PubMed  Google Scholar 

  11. Strasberg SM. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180:101–25.

    PubMed  CAS  Google Scholar 

  12. Gastrointestinal surgery for severe obesity. National Institutes of Health Consensus Development Conference Draft Statement. Obes Surg 1991; 1: 257–66.

    Google Scholar 

  13. Tint GS, Salen G, Colalillo A et al. Ursodeoxycholic acid: a safe and effective agent for dissolving cholesterol gallstones. Ann Intern Med 1982; 97: 351–6.

    PubMed  CAS  Google Scholar 

  14. Salen G. Gallstone dissolution therapy with ursodiol. Efficacy and safety. Dig Dis Sci 1989; 34: 39S–43S.

    Article  PubMed  CAS  Google Scholar 

  15. Taylor J, Leitman IM, Horowitz M. Is routine cholecystectomy necessary at the time of Roux-en-Y gastric bypass? Obes Surg 2006; 16: 759–61.

    Article  PubMed  Google Scholar 

  16. Guadalajara H, Sanz Baro R, Pascual I et al. Is prophylactic cholecystectomy useful in obese patients undergoing gastric bypass? Obes Surg 2006; 16: 883–5.

    Article  PubMed  Google Scholar 

  17. Swartz DE, Felix EL. Elective cholecystectomy after Roux-en-Y gastric bypass: why should asymptomatic gallstones be treated differently in morbidly obese patients? Surg Obes Relat Dis 2005; 1: 555–60.

    Article  PubMed  Google Scholar 

  18. Caruana JA, McCabe MN, Smith AD et al. Incidence of symptomatic gallstones after gastric bypass: is prophylactic treatment really necessary? Surg Obes Relat Dis 2005; 1: 564–7.

    Article  PubMed  Google Scholar 

  19. 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: 857–61.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of California, Davis, 2221 Stockton Boulevard, Sacramento, CA, 95817, USA

    William Fuller MD, Jason J. Rasmussen MD & Mohamed R. Ali MD

  2. Department of Biostatistics, University of California, Davis, Sacramento, CA, USA

    Jagannath Ghosh BS

Authors
  1. William Fuller MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jason J. Rasmussen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jagannath Ghosh BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed R. Ali MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohamed R. Ali MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fuller, W., Rasmussen, J.J., Ghosh, J. et al. Is Routine Cholecystectomy Indicated for Asymptomatic Cholelithiasis in Patients Undergoing Gastric Bypass?. OBES SURG 17, 747–751 (2007). https://doi.org/10.1007/s11695-007-9138-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-007-9138-7

Key words

Search

Navigation