title: Cholecystectomy after gastric bypass-incidence and complications.
abstract: BACKGROUND
  Although cholecystectomy incidence is known to be high after Roux-en-Y gastric bypass (RYGB) surgery, the actual increase in incidence is not known. Furthermore, the outcome of cholecystectomy after RYGB is not known.
  
  
  OBJECTIVE
  To estimate cholecystectomy incidence before and after RYGB and to compare the outcome of post-RYGB cholecystectomy with the cholecystectomy outcome in the background population.
  
  
  METHODS
  Nationwide Swedish multiregister study.
  
  
  METHODS
  The Swedish Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (n = 79,386) and the Scandinavian Obesity Surgery Registry (n = 36,098) were cross-matched for the years 2007 through 2013 and compared with the National Patient Register.
  
  
  RESULTS
  The standardized incidence ratio for cholecystectomy before RYGB was 3.42 (2.75-4.26, P<.001); the ratio peaked at 11.4 (10.2-12.6, P<.001) 6-12 months after RYGB, which was 3.54 times the baseline level (2.78-4.49, P<.001). After 36 months, the incidence ratio had returned to baseline. The post-RYGB group demonstrated an increased risk of 30-day postoperative complications after cholecystectomy (odds ratio 2.13, 1.78-2.56; P<.001), including reoperation (odds ratio 3.84, 2.76-5.36; P<.001), compared with the background population. The post-RYGB group also demonstrated a higher risk of conversion, acute cholecystectomy, and complicated gallstone disease and a slightly prolonged operative time, adjusted for age, sex, American Society of Anesthesiologists class, and previous open RYGB.
  
  
  CONCLUSIONS
  Compared with the background population, the incidence of cholecystectomy was substantially elevated already before RYGB and increased further 6-36 months after RYGB. Previous RYGB doubled the risk of postoperative complications after cholecystectomy and almost quadrupled the risk of reoperation, even when intraoperative cholangiography was normal.
authors.affiliation: Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. Electronic address: wanjura@telia.com.
authors.forename: Viktor
authors.initials: V
authors.lastname: Wanjura
authors.affiliation: Department of Surgical Gastroenterology, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden; Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandblom
authors.affiliation: Department of Surgery, Mora Hospital, Mora, Sweden.
authors.forename: Johanna
authors.initials: J
authors.lastname: Österberg
authors.affiliation: Department of Surgical and Perioperative Sciences, Division of Surgery, Sunderby Hospital, Umeå University, Umeå, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Enochsson
authors.affiliation: Department of Surgery, Faculty of Medicine and Health, Örebro University, Lindesberg, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Ottosson
authors.affiliation: Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Szabo
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D005260:Female; D042882:Gallstones / Q000453:epidemiology / Q000601:surgery; D015390:Gastric Bypass / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology; D011182:Postoperative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D024162:Second-Look Surgery / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology
keywords: Bariatric surgery; Cholecystectomy; Gallstone; Gastric bypass; Obesity