Simultaneous Cholecystectomy: to be or not to be

BACKGROUND: the argument concerning the justification for doing cholecystectomy at the same time as a gastric limiting procedure for morbid obesity continues to be a lively one. This study is an attempt to resolve this issue by reviewing the data of a single surgeon over the 10 year period from January 1983 through April of 1993. METHODS: the first 3 years of the study (386 patients) involved primary gastroplasty with or without cholecystectomy. In 1986, the author began doing Roux-Y gastric bypass which has included 673 consecutive patients. At the same time, our criteria for simultaneous cholecystectomy changed from not only cholelithiasis and cholesterolosis of the gallbladder, but also to a strong family history of biliary tract disease which necessitated surgery and clinical evidence of chronic cholecystitis at surgery, i.e. thickening of the gallbladder wall and more than the usual amount of adhesions. FINDINGS: in the 1983-1986 group, 13% needed a second operation for symptomatic binary tract disease sometime between 1 and 9 years after surgery. In the latter group from 1986 to 1993, 9% have necessitated cholecystectomy, usually several years following the original Roux-Y gastric bypass. CONCLUSIONS: we conclude that simultaneous cholecystectomy be based on the above criteria rather than being done routinely.