Is routine cholecystectomy indicated for asymptomatic cholelithiasis in patients undergoing gastric bypass?

William Fuller, Jason J. Rasmussen, Jagannath Ghosh, Mohamed R Ali

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

Background: The purpose of this study was to evaluate the natural history of patients undergoing Rouxen-Y gastric bypass (RYGBP) with known asymptomatic cholelithiasis in whom prophylactic cholecystectomy was not performed at the time of surgery. Methods: The records of 144 consecutive patients from a single year experience in RYGBP surgery at the University of California, Davis Medical Center were reviewed. Patients undergoing RYGBP were routinely screened for cholelithiasis by ultrasound. Patients who did not have cholecystectomy were managed with ursodiol for 6 months postoperatively. Results: 13 males (9.0%) and 131 females (91%) underwent RYGBP. The mean age was 43 years (SD 8.55), and mean BMI was 46 kg/m2 (SD 6.5). The comorbidities of our patient population included diabetes (14%), hypertension (48%), gastroesophageal reflux disease (50%), dyslipidemia (35%), obstructive sleep apnea (31%), and musculoskeletal complaints (69%). 22 patients were diagnosed with cholelithiasis by ultrasonography preoperatively. 9 of these patients (41%) were symptomatic and underwent concurrent cholecystectomy and RYGBP. The remaining 13 patients (59%) had asymptomatic cholelithiasis preoperatively but did not undergo cholecystectomy at the time of surgery. Only one of these asymptomatic patients eventually developed symptoms necessitating cholecystectomy at up to 1 year follow-up. Conclusions: Our data suggest that it may not be absolutely indicated to perform prophylactic cholecystectomy at the time of RYGBP surgery for asymptomatic cholelithiasis. We believe that this phenomenon needs to be further studied in a randomized trial.

Original languageEnglish (US)
Pages (from-to)747-751
Number of pages5
JournalObesity Surgery
Volume17
Issue number6
DOIs
StatePublished - Aug 2007

Keywords

  • Bariatric surgery
  • Cholecystectomy
  • Gallstones
  • Gastric bypass
  • Laparoscopy
  • Morbid obesity
  • Ursodiol

ASJC Scopus subject areas

  • Surgery

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