The case for prophylactic cholecystectomy concomitant with gastric restriction for morbid obesity

The pre and postoperative incidence of cholelithiasis were investigated in patients undergoing bariatric surgery at the University of Florida. The first part of the study was retrospective and revealed a pre and 24-month postoperative incidence of cholelithiasis of 30 and 40 percent respectively. Age and postoperative interval were not predictive of cholelithiasis. Patients with cholelithiasis had a significantly greater weight loss (130 +/- 61.0 lbs) than those without stones (109 +/- 59.9 lbs) P = 0.04. Men had a significantly greater weight loss than women (160 +/- 15 lbs SEM versus 99 +/- 7 lbs SEM) as well as a higher incidence of cholelithiasis (53 and 24%, respectively). In the second, prospective part of the study, cholecystectomy was performed in 73 consecutive patients concomitant with their bariatric procedure. Ninety six per cent of removed gallbladders had gross or histologic abnormalities including cholelithiasis in 27 per cent and cholesterolosis/cholecystitis in 69 per cent. The incidence of cholelithiasis was higher than that found in the retrospective series by preoperative ultrasound. The bariatric surgical patient is clearly at risk for the development of postoperative cholelithiasis and cholecystitis. The risk appears to be related to the amount of weight loss. In addition, some gallstones may remain undetected at the time of surgery. We therefore recommend prophylactic cholecystectomy at the time of bariatric surgery.