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Is routine cholecystectomy required during laparoscopic gastric bypass?
Leonardo Villegas1, Benjamin Schneider, David Provost
1Southwestern Center for Minimally Invasive Surgery, University of Texas Southwestern Medical Center at Dallas, TX, USA.
Obesity Surgery
|March 17, 2004
Summary
Gallstone formation after laparoscopic Roux-en-Y gastric bypass (LRYGBP) is uncommon. Prophylactic ursodiol may help prevent gallstones in patients undergoing LRYGBP.
Area of Science:
- Bariatric Surgery
- Gastroenterology
- Hepatology
Background:
- Morbid obesity often necessitates bariatric surgery, with gastric bypass being a common procedure.
- Cholecystectomy is frequently performed concurrently with gastric bypass surgery.
- The study investigates gallstone incidence post-laparoscopic Roux-en-Y gastric bypass (LRYGBP).
Purpose of the Study:
- To determine the incidence of gallstone formation requiring cholecystectomy after LRYGBP.
- To evaluate the effectiveness of prophylactic ursodiol in preventing gallstones.
- To assess the role of intra-operative ultrasound (IOUS) and selective cholecystectomy.
Main Methods:
- 289 LRYGBP procedures were analyzed.
- Patients with prior cholecystectomy were excluded.
- Intra-operative ultrasound (IOUS) identified gallstones; simultaneous cholecystectomy was performed if detected. Patients without gallstones received ursodiol for 6 months and follow-up ultrasound.
Main Results:
- 14% of patients had gallstones detected during LRYGBP via IOUS.
- Postoperative ultrasound revealed new gallstones in 22% and sludge in 8% of patients.
- 7% of patients developed symptomatic gallstones requiring cholecystectomy; ursodiol compliance was lower in patients who developed stones.
Conclusions:
- Symptomatic gallstone incidence after LRYGBP is low.
- Prophylactic ursodiol demonstrates a protective effect against gallstone formation.
- Routine IOUS with selective cholecystectomy and close follow-up is a reasonable strategy.