title: Safety of laparoscopic adjustable gastric banding with concurrent cholecystectomy for symptomatic cholelithiasis.
abstract: BACKGROUND
  The prevalence of cholelithiasis correlates with obesity. Patients often present for bariatric surgery with symptomatic cholelithiasis. There is a concern of cross-contamination when performing laparoscopic adjustable gastric banding (LAGB) with concurrent cholecystectomy. The primary goal of this study is to address the safety and feasibility of this practice.
  
  
  METHODS
  A retrospective cohort study was designed from a prospectively collected database. All LAGB patients from July 2005 to April 2013 were included. Patients undergoing LAGB with concurrent cholecystectomy comprised the study group (LAGB/chole). The control group (LAGB) consisted of patients undergoing LAGB alone, and was selected using a 3:1 (control:study) case-match based on demographic and comorbidity data. The primary outcome was overall complication rate, with secondary outcomes including operating room (OR) time, length of stay (LOS), 30-day readmission/reoperation, erosion, infection, and band/port revisional surgery.
  
  
  RESULTS
  There were 4,982 patients who met criteria. Of these, 28 patients had a LAGB with concurrent cholecystectomy, comprising the LAGB/chole (study) group. The remaining 4,954 patients were eligible controls, of which 84 were selected for the LAGB (control) group. Demographic and comorbidity data, along with mean follow-up time, were similar between the two groups. OR time was longer in the LAGB/chole group, but LOS was the same. The overall complication rate in the LAGB/chole group was 21 (n = 6) versus 20% (n = 17) in the LAGB group (p = 0.893). Thirty-day readmission and reoperation were similar. There was also no difference in port site, wound, and intra-abdominal infections. There were no band erosions in either group.
  
  
  CONCLUSIONS
  Performing a concurrent cholecystectomy at the time of LAGB does not result in increased immediate or delayed morbidity. Although longer to perform, this safe operation would avoid a second surgery for a patient already diagnosed with symptomatic cholelithiasis.
authors.affiliation: Department of Surgery, New York University School of Medicine, 530 First Ave., Suite 10S, New York, NY, 10016, USA, nabeel.obeid@nyumc.org.
authors.forename: Nabeel R
authors.initials: NR
authors.lastname: Obeid
authors.forename: Marina S
authors.initials: MS
authors.lastname: Kurian
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Ren-Fielding
authors.forename: George A
authors.initials: GA
authors.lastname: Fielding
authors.forename: Bradley F
authors.initials: BF
authors.lastname: Schwack
mesh_terms: D002763:Cholecystectomy / Q000009:adverse effects*; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D059413:Intraabdominal Infections / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D061646:Operative Time; D010359:Patient Readmission; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology