Is prophylactic cholecystectomy useful in obese patients undergoing gastric bypass?
BACKGROUND
Obesity constitutes a clear risk factor for cholelithiasis, especially if it is associated with a rapid weight loss, as is the case of patients following bariatric surgery. Prophylactic cholecystectomy is indicated in biliopancreatic diversions due to the high incidence of postoperative cholelithiasis. However, there is no agreement on gastric bypass. This study was conducted to establish the incidence of cholecystopathy demonstrated by histology and to assess the indication for prophylactic cholecystectomy in a systematic way on patients undergoing gastric bypass.


METHODS
The evaluation is based on 100 consecutive morbidly obese patients undergoing open gastric bypass surgery with concomitant prophylactic cholecystectomy. Variables studied were: age, gender, body mass index, preoperative ultrasound and the anatomopathologic analysis of the gallbladder that was removed.


RESULTS
Of the 100 patients who took part in the trial, 11 had had a previous cholecystectomy. Among the 89 patients remaining, preoperative ultrasound diagnosis of cholelithiasis was 16.8%, and the actual postoperative incidence was 24.7%. Other histologic alterations were: cholesterolosis 46.1%, chronic unspecified cholecystitis 22.5%, and granulomatous cholecystitis 1.1%. The total incidence of cholecystopathy was 93.3%. The morbi-mortality related to cholecystectomy was 0%.


CONCLUSIONS
Based on these results and given the absence of morbidity, we believe that prophylactic cholecystectomy is suitable during open gastric bypass.
Guadalajara
Héctor
H
Department of General Surgery, Hospital Universitario La Paz, Madrid, Spain. h_guadalajara@yahoo.com
Sanz Baro
Raquel
R
Pascual
Isabel
I
Blesa
Isabel
I
Rotundo
Grevelyn Sosa
GS
López
Jose María Gil
JM
Corripio
Ramón
R
Vesperinas
Gregorio
G
Sancho
Luis García
LG
Montes
Jose Antonio Rodríguez
JA
D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D015897:Comorbidity; D005260:Female; D015390:Gastric Bypass / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D016896:Treatment Outcome