title: Prophylactic cholecystectomy, a mandatory step in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass?
abstract: BACKGROUND
  The aim of this study was to determine the incidence of symptomatic gallstone disease requiring cholecystectomy (CCE) after laparoscopic Roux-en-Y gastric bypass (LRYGBP) and to identify the peri-operative risk factors associated with postoperative symptomatic gallstone disease.
  
  
  METHODS
  Between August 2003 and November 2009, 724 patients underwent LRYGBP at the Groeninge Hospital. Preoperative ultrasound was performed in 600 of 641 patients without history of CCE and 120 (20.0%) were diagnosed with cholecystolithiasis.
  
  
  RESULTS
  Six hundred twenty-five patients were included, 43(6.9%) developed delayed symptoms related to biliary disease. Of these 43 patients, 39 underwent post-LRYGBP CCE. Of these 39 patients, 9 (7.5%) had a positive ultrasound prior to LRYGBP. Multivariate analysis identified weight loss at 3 months post-LRYGB of more than 50% of excess weight [HR (95% CI), 2.04 (1.04-4.28); p = 0.037) as the sole significant independent predictor of delayed symptomatic cholecystolithiasis.
  
  
  CONCLUSIONS
  Symptomatic gallstone disease occurred only in 6.9% of patients post-LRYGBP. Multivariate analysis identified weight loss at 3 months post-LRYGBP of more than 50% of excess weight as the sole significant independent predictor of delayed symptomatic cholecystolithiasis. Prophylactic CCE should not be recommended at the time of LRYGBP.
authors.affiliation: Department of Digestive Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium. mathieudhondt2000@yahoo.com
authors.forename: Mathieu
authors.initials: M
authors.lastname: D'Hondt
authors.forename: Gregory
authors.initials: G
authors.lastname: Sergeant
authors.forename: Bert
authors.initials: B
authors.lastname: Deylgat
authors.forename: Dirk
authors.initials: D
authors.lastname: Devriendt
authors.forename: Frank
authors.initials: F
authors.lastname: Van Rooy
authors.forename: Franky
authors.initials: F
authors.lastname: Vansteenkiste
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D041761:Cholecystolithiasis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery; D016016:Proportional Hazards Models; D013997:Time Factors; D014463:Ultrasonography; D015431:Weight Loss; D055815:Young Adult