title: Potential Benefits of Prophylactic Cholecystectomy in Patients Undergoing Bariatric Bypass Surgery.
abstract: BACKGROUND
  In patients with morbid obesity, laparoscopic Roux-en-Y gastric bypass (LRYGB) is the treatment of choice. Patients with gallstones routinely undergo cholecystectomy at the same time as LRYGB. Although the risk of developing gallstones afterwards is high, prophylactic cholecystectomy during LRYGB remains controversial. Therefore, we conducted a retrospective study to evaluate the risk associated with prophylactic cholecystectomy and risk factors for developing gallstones after LRYGB.
  
  
  METHODS
  Data for patients on whom we consecutively performed LRYGB in 2003-2008 were extracted from the prospective bariatric database. The primary endpoint of the study was detection of newly developed gallstones by ultrasonography, and the secondary endpoint was evaluation of the incidence of post-LRYGB cholecystectomy (questionnaire).
  
  
  RESULTS
  Of 117 patients who underwent LRYGB, 20 (17 %) had a previous and 26 (22 %) had a concomitant cholecystectomy. Of the 71 LRYGB patients remaining who had not had their gallbladders removed, 22 (34 %) developed gallstones, with 11 (17 %) requiring emergency cholecystectomy before the study began. Seven (10 %) patients were lost to follow-up, and 53 (75 %) underwent abdominal ultrasound during follow-up, which detected stones in another 11 (17 %) patients up to end of the study period.
  
  
  CONCLUSIONS
  Nearly 50 % of our patients had either experienced gallstones before LRYGB or developed gallstones after LRYGB. In the group with new gallstone development, 50 % required emergency cholecystectomy. These results, together with the reported better quality of life after a combined procedure and the reported economic benefits, support the use of concomitant prophylactic cholecystectomy in patients undergoing LRYGB.
authors: Department of Surgery, HFR Fribourg Cantonal Hospital, 1708, Fribourg, Switzerland. sebastien.amstutz@hcuge.ch.
authors: Sébastien
authors: S
authors: Amstutz
authors: Department of Surgery, HFR Fribourg Cantonal Hospital, 1708, Fribourg, Switzerland. micheljeanmarie@yahoo.fr.
authors: Jean-Marie
authors: JM
authors: Michel
authors: Department of Radiology, HFR Fribourg Cantonal Hospital, 1708, Fribourg, Switzerland. sebastien.kopp@gmail.com.
authors: Sébastien
authors: S
authors: Kopp
authors: Department of Surgery, HFR Fribourg Cantonal Hospital, 1708, Fribourg, Switzerland. bernhard-egger@bluewin.ch.
authors: Bernhard
authors: B
authors: Egger
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D005260:Female; D042882:Gallstones / Q000453:epidemiology / Q000517:prevention & control* / Q000601:surgery; D015390:Gastric Bypass / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D065286:Prophylactic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: Bariatric surgery; Gallstone disease; Gallstones; Prophylactic cholecystectomy; Roux-en-Y gastric bypass