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Updated: Apr 19, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
Concomitant cholecystectomy should be routinely performed with laparoscopic Roux-en-Y gastric bypass
Anna C Weiss1, Tazo Inui2, Ralitza Parina2
1Department of Surgery, University of California, San Diego, 200 W. Arbor Drive, MC 8402, San Diego, CA, 92103, USA. A3weiss@ucsd.edu.
Insights
Performing a concomitant cholecystectomy during Roux-en-Y Gastric Bypass (RYGB) surgery improves survival and long-term outcomes. This approach is safer than a delayed gallbladder removal after RYGB, reducing risks and complications.
Area of Science:
- Bariatric Surgery
- Gastrointestinal Surgery
- Surgical Outcomes
Background:
- Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is now preferred over open surgery.
- Concomitant cholecystectomy rates have declined with RYGB popularity.
- Previous studies lacked long-term outcomes and survival data for concomitant cholecystectomy during RYGB.
Purpose of the Study:
- To evaluate the long-term survival and outcomes of concomitant cholecystectomy during RYGB.
- To compare the risks of cholecystectomy performed during RYGB versus after RYGB.
Main Methods:
- Querying the California Office of Statewide Health Planning and Development database (1995-2009).
- Analyzing 134,584 RYGB patients, comparing those with and without concomitant cholecystectomy.
- Comparing 7,099 patients who underwent cholecystectomy after RYGB to all cholecystectomy patients.
- Utilizing Cox proportional hazard analysis for survival and outcome assessment.
Main Results:
- Concomitant cholecystectomy in 21,022 RYGB patients improved survival (HR 0.51) and long-term outcomes (HR 0.84).
- Gallbladder disease incidence post-RYGB was 6.8% at 1 year and 15.2% at 5 years.
- Cholecystectomy after RYGB was associated with higher risks of conversion to open surgery (HR 1.58), complications (HR 1.47), and death (HR 1.32).
Conclusions:
- Concomitant cholecystectomy is a safe procedure for RYGB patients.
- Considering the high incidence of gallbladder disease and risks of delayed cholecystectomy, it should be performed during RYGB.
- This strategy enhances patient safety and long-term health outcomes.
Introduction:
As the popularity of a laparoscopic Roux-en-Y Gastric Bypass (RYGB) surpassed that of an open approach, practice of concomitant cholecystectomy declined. Low rates of gallbladder disease following RYGB and high complication rates of concomitant cholecystectomy have been published, but these population-based studies have lacked long-term outcomes and survival data.
Study Design:
The California Office of Statewide Health Planning and Development longitudinal database was queried for patients who underwent RYGB with or without cholecystectomy between 1995 and 2009. Additionally, patients who underwent cholecystectomy after RYGB were compared to all cholecystectomy patients. Primary outcome was survival; secondary long-term outcomes included cholangitis, common duct stones, dumping syndrome, metabolic derangements, ventral hernia, any hernia, marginal ulcers, and reoperation. Cox proportional hazard analysis was performed to determine adjusted survival and outcomes.
Results:
Of 134,584 RYGB patients, 21,022 underwent concomitant cholecystectomy. Concomitant cholecystectomy improved both survival (HR[95 % CI] 0.51[.48-.54]) and long-term outcomes (HR 0.84[.77-.91]). Incidence of gallbladder disease following RYGB was 6.8 and 15.2 % at 1 and 5 years. In subsequent analysis of 829,333 cholecystectomy patients, 7,099 underwent prior RYGB with higher risk of conversion to open (HR 1.58[1.41-1.78]), post-operative complication (HR 1.47[1.36-1.6]) and death (HR 1.32[1.17-1.5]).
Conclusions:
Concomitant cholecystectomy is safe for RYGB patients. Given high rates of gallbladder disease and increased risk when cholecystectomy is performed following RYGB, cholecystectomy should be considered at the time of RYGB.
