Prophylactic cholecystectomy with open gastric bypass operation

There has been controversy regarding prophylactic cholecystectomy with Roux-en Y gastric bypass. The results reported in open cases showed no significant increase in morbidity by the addition of cholecystectomy. A series of open cases were reviewed to evaluate the propriety of prophylactic cholecystectomy.

The records of 141 patients undergoing cholecystectomy during open gastric bypass were reviewed, documenting age, ultrasound findings and pathology.

Of the 141 cases analyzed, the incidence of gall-bladder pathology was 80%. 24 (17%) of the 141 patients were noted to have gallstones on preoperative ultrasound examination, and 3 (2%) showed polyps. 9 patients (6%) had gallstones at surgery with normal ultrasound. Cholesterolosis was present in 52 cases (37%) and chronic cholecystitis in 25 cases (18%).

In view of the high incidence of gall-bladder disease (80%) already present in morbidity obese patients undergoing gastric bypass and the lack of significant morbidity in open surgery with prophylactic cholecystectomy, the addition of prophylactic cholecystectomy appears appropriate.