title: Concomitant cholecystectomy during laparoscopic Roux-en-Y gastric bypass in obese patients is not justified: a meta-analysis.
abstract: While LRYGB has become a cornerstone in the surgical treatment of morbidly obese patients, concomitant cholecystectomy during LRYGB remains a matter of debate. The aim of this meta-analysis was to estimate the rate and morbidity of subsequent cholecystectomy after laparoscopic Roux-en-Y gastric bypass (LRYGB) in obese patients. A meta-analysis was performed analyzing the rate and morbidity of subsequent cholecystectomy in patients who underwent LRYGB without concomitant cholecystectomy. Thirteen studies met the inclusion criteria. The rate of subsequent cholecystectomy was 6.8 % (95 % CI, 5.0-8.7 %) based on 6,048 obese patients who underwent LRYGB without concomitant cholecystectomy. The rate of subsequent cholecystectomy due to biliary colic or gallbladder dyskinesia was 5.3 %; due to cholecystitis, 1.0 %; choledocholithiasis, 0.2 %; and biliary pancreatitis, 0.2 %. The mortality after subsequent cholecystectomy was 0 % (95 % CI, 0-0.1 %). The surgery-related complication rate after subsequent cholecystectomy was 1.8 % (95 % CI, 0.7-3.4 %) resulting in a risk of 0.1 % (95 % CI, 0.03-0.3 %) to suffer from a cholecystectomy-related complication in patients undergoing LRYGB without concomitant cholecystectomy. A prophylactic concomitant cholecystectomy during LRYGB should be avoided in patients without cholelithiasis and exclusively be performed in patients with symptomatic biliary disease.
authors: Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland.
authors: Rene
authors: R
authors: Warschkow
authors: Ignazio
authors: I
authors: Tarantino
authors: Kristjan
authors: K
authors: Ukegjini
authors: Ulrich
authors: U
authors: Beutner
authors: Ulrich
authors: U
authors: Güller
authors: Bruno M
authors: BM
authors: Schmied
authors: Sascha A
authors: SA
authors: Müller
authors: Bernd
authors: B
authors: Schultes
authors: Martin
authors: M
authors: Thurnheer
mesh_terms: D001657:Biliary Dyskinesia / Q000209:etiology / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000706:statistics & numerical data; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery; D003085:Colic / Q000209:etiology / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*; D019564:Unnecessary Procedures