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Is routine cholecystectomy justified in severely obese patients undergoing a laparoscopic Roux-en-Y gastric bypass
Ignazio Tarantino1, Renè Warschkow, Thomas Steffen
1Department of Surgery, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland. Ignazio.Tarantino@kssg.ch
Background:
The aim of the present study was to evaluate the risks and benefits of concurrent prophylactic cholecystectomy (CPC) during laparoscopic Roux-en-Y gastric bypass (LRYGB).
Methods:
From December 2000 to November 2006, CPC during LRYGB was only performed in the presence of gallbladder pathology (n = 140). Beginning in December 2006, CPC was performed during all LRYGB procedures (n = 134). Exclusion criteria were open bypass procedure, previous bariatric surgery other than gastric banding, and previous cholecystectomy (CCE) or necessary concurrent CCE due to gallbladder pathology.
Results:
During a median follow-up of 3.1 years, 26 (18.6%; 95% CI, 12.9-25.9%) of 140 patients without CPC subsequently required a CCE, leading to a gallbladder disease-free survival rate at 5 years of 77.4% (95% CI, 67.3-87.6%). Multivariate analysis identified a distal LRYGB and excess weight loss of >75% at 2 years to be significant risk factors for the development of biliary complications while a preoperative BMI > 50 m(2)/kg was protective. In the second series, prophylactic CCE was not associated with prolonged hospitalization or operative time. The postoperative complications were not related to the CPC.
Conclusions:
The present data indicate that a substantial number of patients develop gallbladder complications after LRYGB. Furthermore, CPC can safely be performed during LRYGB. Based on these findings, CPC should be considered a reasonable approach in severely obese patients undergoing LRYGB.
