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Gallbladder management in obesity surgery.
Edward E Mason1, Kathleen E Renquist
1International Bariatric Surgery Registry, University of Iowa College of Medicine, Department of Surgery, Iowa City, IA, USA. edward-mason@uiowa.edu
Obesity Surgery
|April 27, 2002
Summary
Routine gallbladder removal during bariatric surgery is increasingly common, especially with malabsorptive procedures. Ursodeoxycholic acid is used to prevent gallstones in one-third of patients when the gallbladder is preserved.
Area of Science:
- Bariatric Surgery
- Gastroenterology
- Surgical Oncology
Background:
- Historical recommendations for routine cholecystectomy during bariatric surgery due to gallstone prevalence in obesity.
- Concerns regarding increased gallbladder disease risk from rapid weight loss post-bariatric surgery.
- Evolving standard of care for cholecystectomy in the context of rising obesity rates and gastric reduction surgeries.
Purpose of the Study:
- To review the current standard of care for prophylactic cholecystectomy in bariatric surgery patients.
- To assess the contemporary use of ursodeoxycholic acid for gallstone prevention in this population.
Main Methods:
- Analysis of data from the 28th International Bariatric Surgery Registry (IBSR).
- Surveys sent to members of the American Society for Bariatric Surgery (ASBS) regarding cholecystectomy indications and ursodeoxycholic acid usage.
Main Results:
- Increased rates of concurrent cholecystectomy over the past 15 years, linked to a shift towards gastric bypass procedures.
- All patients undergoing extensive intestinal bypass (distal Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch) had cholecystectomies.
- Ursodeoxycholic acid is used in one-third of patients with normal-appearing gallbladders left in place during standard Roux-en-Y gastric bypass.
Conclusions:
- Prophylactic cholecystectomy during Roux-en-Y gastric bypass (RYGBP) is surgeon-dependent.
- Concurrent cholecystectomy and malabsorptive procedures have increased.
- Gallbladders are routinely removed with extensive small bowel bypass but often preserved with simple gastric restriction; ursodeoxycholic acid use is common for prevention when gallbladders remain.