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Is routine cholecystectomy indicated for asymptomatic cholelithiasis in patients undergoing gastric bypass?
William Fuller1, Jason J Rasmussen, Jagannath Ghosh
1Department of Surgery, University of California, Davis, Sacramento, CA 95817, USA.
Insights
Prophylactic cholecystectomy may not be necessary for all patients with asymptomatic gallstones undergoing Roux-en-Y gastric bypass (RYGBP). Most patients with asymptomatic cholelithiasis managed conservatively after RYGBP did not develop complications within a year.
Area of Science:
- Bariatric Surgery
- Gastroenterology
- Surgical Outcomes
Background:
- Roux-en-Y gastric bypass (RYGBP) is a common bariatric procedure.
- Cholelithiasis (gallstones) is a known potential complication.
- The necessity of prophylactic cholecystectomy for asymptomatic gallstones during RYGBP is debated.
Purpose of the Study:
- To evaluate the natural history of asymptomatic cholelithiasis in patients undergoing RYGBP.
- To determine the rate of symptomatic gallstone development after RYGBP without prophylactic cholecystectomy.
Main Methods:
- Retrospective review of 144 RYGBP patients.
- Preoperative screening for cholelithiasis using ultrasound.
- Conservative management with ursodiol for patients with asymptomatic gallstones.
Main Results:
- 22 patients had preoperative cholelithiasis; 13 had asymptomatic gallstones and did not undergo cholecystectomy.
- Only 1 of these 13 patients developed symptomatic gallstones requiring surgery within 1 year.
- The majority of patients with asymptomatic cholelithiasis tolerated RYGBP without immediate cholecystectomy.
Conclusions:
- Prophylactic cholecystectomy may not be an absolute indication for all RYGBP patients with asymptomatic cholelithiasis.
- Conservative management appears safe for select patients.
- Further investigation via randomized trials is recommended to confirm these findings.
Background:
The purpose of this study was to evaluate the natural history of patients undergoing Roux-en-Y gastric bypass (RYGBP) with known asymptomatic cholelithiasis in whom prophylactic cholecystectomy was not performed at the time of surgery.
Methods:
The records of 144 consecutive patients from a single year experience in RYGBP surgery at the University of California, Davis Medical Center were reviewed. Patients undergoing RYGBP were routinely screened for cholelithiasis by ultrasound. Patients who did not have cholecystectomy were managed with ursodiol for 6 months postoperatively.
Results:
13 males (9.0%) and 131 females (91%) underwent RYGBP. The mean age was 43 years (SD 8.55), and mean BMI was 46 kg/m2 (SD 6.5). The comorbidities of our patient population included diabetes (14%), hypertension (48%), gastroesophageal reflux disease (50%), dyslipidemia (35%), obstructive sleep apnea (31%), and musculoskeletal complaints (69%). 22 patients were diagnosed with cholelithiasis by ultrasonography preoperatively. 9 of these patients (41%) were symptomatic and underwent concurrent cholecystectomy and RYGBP. The remaining 13 patients (59%) had asymptomatic cholelithiasis preoperatively but did not undergo cholecystectomy at the time of surgery. Only one of these asymptomatic patients eventually developed symptoms necessitating cholecystectomy at up to 1 year follow-up.
Conclusions:
Our data suggest that it may not be absolutely indicated to perform prophylactic cholecystectomy at the time of RYGBP surgery for asymptomatic cholelithiasis. We believe that this phenomenon needs to be further studied in a randomized trial.
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