Is routine cholecystectomy required during laparoscopic gastric bypass?
BACKGROUND
Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of this study was to determine the incidence of gallstone formation requiring cholecystectomy following a laparoscopic Roux-en-Y gastric bypass (LRYGBP).


METHODS
289 LRYGBP were performed between November 1999 and May 2002. 60 patients (21%) who had prior cholecystectomy were excluded. If gallstones were identified by intra-operative ultrasound (IOUS), simultaneous cholecystectomy was performed. Patients without gallstones were prescribed ursodiol for 6 months and scheduled for follow-up with transabdominal ultrasound.


RESULTS
During LRYGBP, gallstones were detected in 40 patients using IOUS (14%) and simultaneous cholecystectomy was performed. Of 189 patients with no stones identified by IOUS, 151 patients (80%) had a postoperative ultrasound after 6 months. 33 patients developed gallstones (22%) and 12 developed sludge (8%) as demonstrated by ultrasound at the time of follow-up. 11 patients had gallstone-related symptoms and subsequently underwent cholecystectomy (7%). 106 patients (70%) were gallstone-free at the time of ultrasound follow-up. Ursodiol compliance was found to be significantly lower for patients who developed stones than for gallstone-free patients (38.9% vs 58.3%, z =-2.00, P = 0.045).


CONCLUSIONS
There is a low incidence of symptomatic gallstones requiring cholecystectomy after LRYGBP. Prophylactic ursodiol is protective. Routine IOUS and selective cholecystectomy with close patient follow-up is a rational approach in the era of laparoscopy.
Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
Leonardo
L
Villegas
Benjamin
B
Schneider
David
D
Provost
Craig
C
Chang
Daniel
D
Scott
Thomas
T
Sims
Lois
L
Hill
Linda
L
Hynan
Daniel
D
Jones
D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D015992:Body Mass Index; D002763:Cholecystectomy; D005260:Female; D042882:Gallstones / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography