title: Is routine cholecystectomy justified in severely obese patients undergoing a laparoscopic Roux-en-Y gastric bypass procedure? A comparative cohort study.
abstract: BACKGROUND
  The aim of the present study was to evaluate the risks and benefits of concurrent prophylactic cholecystectomy (CPC) during laparoscopic Roux-en-Y gastric bypass (LRYGB).
  
  
  METHODS
  From December 2000 to November 2006, CPC during LRYGB was only performed in the presence of gallbladder pathology (n = 140). Beginning in December 2006, CPC was performed during all LRYGB procedures (n = 134). Exclusion criteria were open bypass procedure, previous bariatric surgery other than gastric banding, and previous cholecystectomy (CCE) or necessary concurrent CCE due to gallbladder pathology.
  
  
  RESULTS
  During a median follow-up of 3.1 years, 26 (18.6%; 95% CI, 12.9-25.9%) of 140 patients without CPC subsequently required a CCE, leading to a gallbladder disease-free survival rate at 5 years of 77.4% (95% CI, 67.3-87.6%). Multivariate analysis identified a distal LRYGB and excess weight loss of >75% at 2 years to be significant risk factors for the development of biliary complications while a preoperative BMI > 50 m(2)/kg was protective. In the second series, prophylactic CCE was not associated with prolonged hospitalization or operative time. The postoperative complications were not related to the CPC.
  
  
  CONCLUSIONS
  The present data indicate that a substantial number of patients develop gallbladder complications after LRYGB. Furthermore, CPC can safely be performed during LRYGB. Based on these findings, CPC should be considered a reasonable approach in severely obese patients undergoing LRYGB.
authors.affiliation: Department of Surgery, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland. Ignazio.Tarantino@kssg.ch
authors.forename: Ignazio
authors.initials: I
authors.lastname: Tarantino
authors.forename: Renè
authors.initials: R
authors.lastname: Warschkow
authors.forename: Thomas
authors.initials: T
authors.lastname: Steffen
authors.forename: Philipp
authors.initials: P
authors.lastname: Bisang
authors.forename: Bernd
authors.initials: B
authors.lastname: Schultes
authors.forename: Martin
authors.initials: M
authors.lastname: Thurnheer
mesh_terms: D000328:Adult; D002763:Cholecystectomy; D015331:Cohort Studies; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000601:surgery*; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index