Potential Benefits of Prophylactic Cholecystectomy in Patients Undergoing Bariatric Bypass Surgery.
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.
['Amstutz|Sébastien|S|', 'Michel|Jean-Marie|JM|', 'Kopp|Sébastien|S|', 'Egger|Bernhard|B|']
D000328:Adult D000368:Aged D017081:Cholecystectomy, Laparoscopic D003131:Combined Modality Therapy D005260:Female D042882:Gallstones D015390:Gastric Bypass D006801:Humans D015994:Incidence D008297:Male D008875:Middle Aged D009767:Obesity, Morbid D011183:Postoperative Complications D065286:Prophylactic Surgical Procedures D011788:Quality of Life D012189:Retrospective Studies D018570:Risk Assessment
Prophylactic cholecystectomy Roux-en-Y gastric bypass Gallstones Bariatric surgery Gallstone disease