Gallbladder management during laparoscopic Roux-en-Y gastric bypass surgery: routine preoperative screening for gallstones and postoperative prophylactic medical treatment are not necessary.
In the bariatric surgery literature, the optimum approach to the gallbladder is controversial. Recommendations range from concomitant cholecystectomy to selective screening and postoperative medical prophylaxis. At our institution, we have taken a highly selective approach where patients are not routinely screened for gallstones, nor are they medically treated postoperatively with bile salts. We have reviewed our experience with this approach. From January 2003 to January 2005, 407 laparoscopic Roux en Y gastric bypasses were performed at UCLA and postoperative outcomes were collected into a prospective database. Exclusion criteria included previous cholecystectomy, a follow-up period less than 6 months, or incomplete records. One hundred ninety-nine patients were included in the study. With a mean follow up period of 17.8 months, 12 (6%) patients required cholecystectomy for gallstone-induced pathology. Laparoscopic removal was performed in 11 (92%) patients. Indications for surgery included acute cholecystitis in five (2.5%) patients, gallstone pancreatitis in two (1%) patients, and biliary colic alone in another five (2.5%) patients. The incidence of symptomatic gallstones requiring cholecystectomy after laparoscopic Roux en Y gastric bypass is low. These results are similar to those from institutions where routine preoperative screening and prophylactic postoperative medical therapy is used. Routine preoperative screening or medical prophylaxis may not be necessary.
Patel
Kevin R
KR
Section of Minimally Invasive and Bariatric Surgery, UCLA School of Medicine, Los Angeles, California, USA.
White
S C
SC
Tejirian
Talar
T
Han
Soo H
SH
Russell
Doug
D
Vira
Darshai
D
Liao
Lingchen
L
Patel
Karina B
KB
Gracia
Carlos
C
Haigh
Phillip
P
Dutson
Erik
E
Mehran
Amir
A
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D001647:Bile Acids and Salts / Q000627:therapeutic use*; D001660:Biliary Tract Diseases / Q000601:surgery; D018890:Chemoprevention; D017081:Cholecystectomy, Laparoscopic; D002764:Cholecystitis / Q000601:surgery; D041761:Cholecystolithiasis / Q000175:diagnosis* / Q000517:prevention & control / Q000601:surgery; D003085:Colic / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000601:surgery; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
D001647:Bile Acids and Salts