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

Journal of Gastrointestinal Surgery, 07/19/2011

D’Hondt M et al. – Symptomatic gallstone disease occurred only in 6.9% of patients post–laparoscopic Roux–en–Y gastric bypass (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 cholecystectomy (CCE) should not be recommended at the time of LRYGBP.

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.

Results

  • 625 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.

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