BACKGROUND: Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of this study was to determine the incidence of gallstone formation requiring cholecystectomy following a laparoscopic Roux-en-Y gastric bypass (LRYGBP). METHODS: 289 LRYGBP were performed between November 1999 and May 2002. 60 patients (21%) who had prior cholecystectomy were excluded. If gallstones were identified by intra-operative ultrasound (IOUS), simultaneous cholecystectomy was performed. Patients without gallstones were prescribed ursodiol for 6 months and scheduled for follow-up with transabdominal ultrasound. RESULTS: During LRYGBP, gallstones were detected in 40 patients using IOUS (14%) and simultaneous cholecystectomy was performed. Of 189 patients with no stones identified by IOUS, 151 patients (80%) had a postoperative ultrasound after 6 months. 33 patients developed gallstones (22%) and 12 developed sludge (8%) as demonstrated by ultrasound at the time of follow-up. 11 patients had gallstone-related symptoms and subsequently underwent cholecystectomy (7%). 106 patients (70%) were gallstone-free at the time of ultrasound follow-up. Ursodiol compliance was found to be significantly lower for patients who developed stones than for gallstone-free patients (38.9% vs 58.3%, z =-2.00, P = 0.045). CONCLUSIONS: There is a low incidence of symptomatic gallstones requiring cholecystectomy after LRYGBP. Prophylactic ursodiol is protective. Routine IOUS and selective cholecystectomy with close patient follow-up is a rational approach in the era of laparoscopy.
BACKGROUND: Routine cholecystectomy is often performed at the time of gastric bypass for morbid obesity. The aim of this study was to determine the incidence of gallstone formation requiring cholecystectomy following a laparoscopic Roux-en-Y gastric bypass (LRYGBP). METHODS: 289 LRYGBP were performed between November 1999 and May 2002. 60 patients (21%) who had prior cholecystectomy were excluded. If gallstones were identified by intra-operative ultrasound (IOUS), simultaneous cholecystectomy was performed. Patients without gallstones were prescribed ursodiol for 6 months and scheduled for follow-up with transabdominal ultrasound. RESULTS: During LRYGBP, gallstones were detected in 40 patients using IOUS (14%) and simultaneous cholecystectomy was performed. Of 189 patients with no stones identified by IOUS, 151 patients (80%) had a postoperative ultrasound after 6 months. 33 patients developed gallstones (22%) and 12 developed sludge (8%) as demonstrated by ultrasound at the time of follow-up. 11 patients had gallstone-related symptoms and subsequently underwent cholecystectomy (7%). 106 patients (70%) were gallstone-free at the time of ultrasound follow-up. Ursodiol compliance was found to be significantly lower for patients who developed stones than for gallstone-freepatients (38.9% vs 58.3%, z =-2.00, P = 0.045). CONCLUSIONS: There is a low incidence of symptomatic gallstones requiring cholecystectomy after LRYGBP. Prophylactic ursodiol is protective. Routine IOUS and selective cholecystectomy with close patient follow-up is a rational approach in the era of laparoscopy.
Authors: Nabeel R Obeid; Marina S Kurian; Christine J Ren-Fielding; George A Fielding; Bradley F Schwack Journal: Surg Endosc Date: 2014-08-27 Impact factor: 4.584
Authors: Jaime Benarroch-Gampel; David R Lairson; Casey A Boyd; Kristin M Sheffield; Vivian Ho; Taylor S Riall Journal: Surgery Date: 2012-09 Impact factor: 3.982
Authors: Ignacio Fuente; Axel Beskow; Fernando Wright; Pedro Uad; Martín de Santibañes; Martin Palavecino; Rodrigo Sanchez-Claria; Juan Pekolj; Oscar Mazza Journal: Surg Endosc Date: 2021-01-04 Impact factor: 4.584