title: Routine gallbladder screening not necessary in patients undergoing laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  Management of the gallbladder in patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP) is controversial. We reviewed our experience in patients undergoing LRYGBP without routine gallbladder screening.
  
  
  METHODS
  The data of 644 patients who underwent LRYGBP at our institution were analyzed. Preoperative ultrasonography was routinely obtained early in our series and selectively thereafter in patients with suspected symptomatic biliary disease. Cholecystectomy at LRYGBP was performed in symptomatic patients with positive ultrasound findings. Postoperatively, patients with intact gallbladders were prescribed ursodiol for 6 months.
  
  
  RESULTS
  Of the 644 patients, 155 (24%) had history of cholecystectomy. A total of 104 patients underwent preoperative ultrasonography. Of the 104 patients, 20 had positive ultrasound findings and symptoms consistent with biliary disease and underwent concomitant cholecystectomy. Twelve patients had positive ultrasound findings and no biliary symptoms and did not undergo cholecystectomy. At a mean follow-up of 26.4 months, only 1 (8.3%) of the 12 patients had required cholecystectomy. Of the 104 patients, 72 had negative ultrasound findings. At a mean follow-up of 21.2 months, 5 of them (6.9%) had required cholecystectomy. The remaining 385 patients did not undergo any gallbladder screening. At a mean follow-up of 14 months, 32 (8.3%) of 385 patients had required cholecystectomy. Compliance with ursodiol for >4 months was only 39%. A time-to-event analysis did not reveal a significant difference in the cholecystectomy rate between asymptomatic patients with preoperative gallbladder screening and patients with no screening.
  
  
  CONCLUSIONS
  Omission of gallbladder screening in asymptomatic patients undergoing LRYGBP is a reasonable approach that spares the patient a potentially unnecessary procedure with all its associated risks.
authors.affiliation: Temple University School of Medicine Clinical Campus at Western Pennsylvania Hospital, Pittsburgh, 15224, USA. ppapasav@wpahs.org
authors.forename: Pavlos K
authors.initials: PK
authors.lastname: Papasavas
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Gagné
authors.forename: Federico A
authors.initials: FA
authors.lastname: Ceppa
authors.forename: Philip F
authors.initials: PF
authors.lastname: Caushaj
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002763:Cholecystectomy / Q000706:statistics & numerical data; D041761:Cholecystolithiasis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015897:Comorbidity; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D005260:Female; D005704:Gallbladder / Q000000981:diagnostic imaging; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011184:Postoperative Period; D011300:Preoperative Care; D012189:Retrospective Studies; D018570:Risk Assessment; D014463:Ultrasonography; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid