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Related Experiment Videos

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
PubMed
Summary
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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.

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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.