Management of concurrent cholelithiasis in gastric banding for morbid obesity

Both morbid obesity and gallstones can be treated using laparoscopic methods. In this study, we share our clinical experience about indications and timing for cholecystectomy in morbid obesity cases that had undergone laparoscopic gastric banding procedure.

In our clinic, 151 cases had undergone laparoscopic adjustable gastric banding procedure between September 2006 and May 2009. Eight cases that were diagnosed with symptomatic cholelithiasis in the preoperative period underwent cholecystectomy in the same session and from the same port of entry. Numerical variables were checked using Mann-Whitney U-test. P value less than 0.05 was considered to be significant.

There were eight adults (six female and two male) with preoperative symptomatic cholelithiasis. Mean age was 28.2 ± 5.8 years, mean preoperative BMI was 44.1 ± 6.8 kg/m², mean operative time was 94.0 ± 18.6 min, and mean duration of hospital stay was 1.5 ± 0.7 days. The same parameters for the group that did not undergo cholecystectomy were mean age=29.6 ± 6.1 years, mean preoperative BMI=46.8 ± 6.6 kg/m², mean operative time=68.2.2 ± 12.9 min, and mean duration of hospital stay=1.2 ± 0.5 days, respectively. In the cholecystectomy group, the mean operative time was 25.8 ± 6.9 min and mean hospital stay was 0.3 ± 0.2 days longer than the laparoscopic adjustable gastric banding group (P=0.003 and 0.159, respectively). In the postoperative period, seven cases (4.8%) developed symptomatic cholelithiasis. The overall average follow-up period was 23.8 ± 8.7 months.

Cholecystectomy performed in the same session as laparoscopic gastric banding procedure on patients with asymptomatic cholelithiasis is a technically feasible approach with low complication rates. However, we do not recommend prophylactic cholecystectomy in patients without gallstones because of longer operative time and hospitalization and increased risk of complications.