Routine cholecystectomy in the morbidly obese

Proven disease is generally considered a sound indication for cholecystectomy. However, incidental removal of a gallbladder with unproven pathology is controversial. The morbidly obese, however, constitute a group at especially high risk for the development of gallbladder disease, with possible greater risk immediately after weight reduction procedures. In our series of 51 consecutive patients undergoing vertical banded gastroplasty (VBG), the gallbladder was routinely removed regardless of symptomatology or results of a preoperative workup. Two patients declined cholecystectomy. Twelve patients (24.4%) had undergone cholecystectomy for symptomatic stones prior to their VBG. Of the remaining 37 subjects, there was a 73% overall incidence of disease: 11 (29.7%) had cholelithiasis, 11 (29.7%) had cholesterolosis alone, three (8.1%) had chronic cholecystitis with cholesterolosis, and two (5.4%) had chronic cholecystitis alone; only 10 (27%) had normal findings. These results, when added to evidence demonstrating a high incidence of postoperative gallbladder disease in those not receiving cholecystectomy, suggest that routine cholecystectomy be considered in all morbidly obese patients undergoing VBG or similar procedures.