title: Concomitant cholecystectomy should be routinely performed with laparoscopic Roux-en-Y gastric bypass.
abstract: BACKGROUND
  As the popularity of a laparoscopic Roux-en-Y Gastric Bypass (RYGB) surpassed that of an open approach, practice of concomitant cholecystectomy declined. Low rates of gallbladder disease following RYGB and high complication rates of concomitant cholecystectomy have been published, but these population-based studies have lacked long-term outcomes and survival data.
  
  
  METHODS
  The California Office of Statewide Health Planning and Development longitudinal database was queried for patients who underwent RYGB with or without cholecystectomy between 1995 and 2009. Additionally, patients who underwent cholecystectomy after RYGB were compared to all cholecystectomy patients. Primary outcome was survival; secondary long-term outcomes included cholangitis, common duct stones, dumping syndrome, metabolic derangements, ventral hernia, any hernia, marginal ulcers, and reoperation. Cox proportional hazard analysis was performed to determine adjusted survival and outcomes.
  
  
  RESULTS
  Of 134,584 RYGB patients, 21,022 underwent concomitant cholecystectomy. Concomitant cholecystectomy improved both survival (HR[95 % CI] 0.51[.48-.54]) and long-term outcomes (HR 0.84[.77-.91]). Incidence of gallbladder disease following RYGB was 6.8 and 15.2 % at 1 and 5 years. In subsequent analysis of 829,333 cholecystectomy patients, 7,099 underwent prior RYGB with higher risk of conversion to open (HR 1.58[1.41-1.78]), post-operative complication (HR 1.47[1.36-1.6]) and death (HR 1.32[1.17-1.5]).
  
  
  CONCLUSIONS
  Concomitant cholecystectomy is safe for RYGB patients. Given high rates of gallbladder disease and increased risk when cholecystectomy is performed following RYGB, cholecystectomy should be considered at the time of RYGB.
authors.affiliation: Department of Surgery, University of California, San Diego, 200 W. Arbor Drive, MC 8402, San Diego, CA, 92103, USA. A3weiss@ucsd.edu.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Weiss
authors.affiliation: Department of Surgery, University of California, San Diego, 200 W. Arbor Drive, MC 8402, San Diego, CA, 92103, USA.
authors.forename: Tazo
authors.initials: T
authors.lastname: Inui
authors.affiliation: Department of Surgery, University of California, San Diego, 200 W. Arbor Drive, MC 8402, San Diego, CA, 92103, USA.
authors.forename: Ralitza
authors.initials: R
authors.lastname: Parina
authors.affiliation: Department of Surgery, University of California, San Diego, 200 W. Arbor Drive, MC 8402, San Diego, CA, 92103, USA.
authors.forename: Alisa M
authors.initials: AM
authors.lastname: Coker
authors.affiliation: Department of Surgery, University of California, San Diego, 200 W. Arbor Drive, MC 8402, San Diego, CA, 92103, USA.
authors.forename: Garth
authors.initials: G
authors.lastname: Jacobsen
authors.affiliation: Department of Surgery, University of California, San Diego, 200 W. Arbor Drive, MC 8402, San Diego, CA, 92103, USA.
authors.forename: Santiago
authors.initials: S
authors.lastname: Horgan
authors.affiliation: Department of Surgery, University of California, San Diego, 200 W. Arbor Drive, MC 8402, San Diego, CA, 92103, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Talamini
authors.affiliation: Department of Surgery, University of California, San Diego, 200 W. Arbor Drive, MC 8402, San Diego, CA, 92103, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.affiliation: Department of Surgery, University of California, San Diego, 200 W. Arbor Drive, MC 8402, San Diego, CA, 92103, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Sandler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Concomitant cholecystectomy; Gallbladder disease after Roux-en-Y; Gastric bypass outcomes