title: Is routine cholecystectomy required during laparoscopic gastric bypass?
abstract: BACKGROUND
  Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of our 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. 39 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 developing 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.
authors.affiliation: Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center at Dallas, TX, USA.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Villegas
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schneider
authors.forename: David
authors.initials: D
authors.lastname: Provost
authors.forename: Craig
authors.initials: C
authors.lastname: Chang
authors.forename: Daniel
authors.initials: D
authors.lastname: Scott
authors.forename: Thomas
authors.initials: T
authors.lastname: Sims
authors.forename: Lois
authors.initials: L
authors.lastname: Hill
authors.forename: Linda
authors.initials: L
authors.lastname: Hynan
authors.forename: Daniel
authors.initials: D
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D015992:Body Mass Index; D002763:Cholecystectomy; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D013270:Stomach / Q000601:surgery*; D013997:Time Factors; D014463:Ultrasonography; D015431:Weight Loss