Is Prophylactic Cholecystectomy Useful in Obese Patients Undergoing Gastric Bypass?

Guadalajara, Héctor; Baro, Raquel Sanz; Pascual, Isabel; Blesa, Isabel; Rotundo, Grevelyn Sosa; López, J M Gil; Corripio, Ramón; Vesperinas, Gregorio; Sancho, Luís; Montes, J. A. Rodríguez

doi:10.1381/096089206777822287

Cited by 43 publications

(28 citation statements)

References 14 publications

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“…Bateson defined the prevalence of cholelithiasis in a given population as the sum of patients with proven cholelithiasis plus those with evidence of prior cholecystectomy [21]. In this study the prevalence of cholelithiasis was 25.9% which is similar to that reported in other studies [22][23][24][25]. The literature reported values between 13.6% and 47.9% [7,14,15,18,22,26].…”

Section: Discussionsupporting

confidence: 84%

Predictors of Gallstone Formation in Morbidly Obese Patients after Bariatric Surgery: A Retrospective Observational Study

Abo-Ryia¹,

Abdallah²,

El-Khadrawy³

et al. 2014

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Background: Obesity alone and rapid weight loss induced by bariatric surgery are recognized risk factors for the development of cholelithiasis. This study aimed to identify the predictive factors for gallstone formation after bariatric surgery. Patient and methods: The files of all morbidly obese patients underwent bariatric surgery in our unit during the period from March 2003 till October 2010 were reviewed and analyzed. All patients underwent routine preoperative ultrasonography and selective concomitant cholecystectomy was done in all patients with ultrasonographic-confirmed cholelithiasis. After excluding cases with prior and concomitant cholecystectomies, patients were divided into two groups; those who developed gallstones and those who did not and the two groups were compared. Results: Of the 143 reviewed files 135 were eligible to be included in the study. The incidence of cholelithiasis before surgery was 25.9% (35 cases). 19 cases (19%) of the 100 cases free at surgery developed gallstone at a mean of 13.2 months. Comparing the two groups, no significant difference was revealed regarding gender, age, preoperative BMI or type of the operation. But the percent of excess weight loss was significantly higher in the group that formed gallstones. Conclusion: Gender, age, preoperative BMI and type of the operation were not predictive of gallstones formation after bariatric surgery. The percent of excess weight loss was the only predictive postoperative factor.

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Section: Discussionsupporting

confidence: 84%

Predictors of Gallstone Formation in Morbidly Obese Patients after Bariatric Surgery: A Retrospective Observational Study

Abo-Ryia¹,

Abdallah²,

El-Khadrawy³

et al. 2014

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“…The incidence of gallstones in morbidly obese patients varies between 21-33% and about 50% of them undergo cholecystectomy prior to bariatric surgery (6,7,(16)(17)(18)(19). In our patient group, gallstones were present in 14 of 60 patients (23.3%), and eight of them (57.1%) had undergone cholecystectomy previously.…”

Section: Discussionmentioning

confidence: 72%

“…These are performing cholecystectomy simultaneously with gastric bypass regardless of the presence of gallstones (prophylactic approach) (6)(7)(8), performing simultaneous cholecystectomy in all patients with gallstones (elective or selective approach) (9, 10), performing simultaneous cholecystectomy in patients with symptomatic gallstones, and methods in which prophylactic ursodeoxycholic acid (UDCA) therapy was initiated or not until development of symptoms (conventional approach) (5,11).…”

Section: Introductionmentioning

confidence: 99%

The evaluation of gallstone formation in patients undergoing Roux-en -Y gastric bypass due to morbid obesity

Karadeniz¹,

Görgün²,

Kara³

2014

UCD

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Objective: This study aimed to evaluate gallstone formation, prophylactic and selective cholecystectomy and the effectiveness of ursodeoxycholic acid treatment following laparoscopic Roux-en -Y gastric bypass (LRYGB) in morbid obese patients. Results: Fifty-three (88.3%) patients were female and seven (11.7%) were male. Eight of the 60 patients (13.3%) had previously undergone cholecystectomy. Six patients (11.5%) underwent cholecystectomy in addition to LRYGB due to preoperatively detected gallstones by ultrasonography. The remaining 46 patients were followed up for a mean duration of 28.57 months (5-56 months). In 10 (21.7%) of these patients, gallstones were detected and five patients with symptomatic gallstones underwent cholecystectomy. Patients who did and did not develop gallstones after LRYGB did not show a significant difference regarding age, gender and the new body mass index (BMI). Three patients were started on ursodeoxycholic acid and the treatment was continued for six months. Gallstones were not detected in these patients. Conclusion:In light of these data, since only a very small portion of patients develops symptomatic gallstones after LRYGB, we recommend cholecystectomy in patients with symptomatic gallstones or the use of ursodeoxycholic acid rather than a prophylactic approach. Prospective randomized controlled studies in larger series are required to support these results.

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“…75 It may be precipitated by rapid weight loss, 76 but the role of prophylactic cholecystectomy during obesity surgery remains controversial. 77,78 Our practise follows the guideline of the routine removal of gallbladders during obesity surgery in all BPD-DS patients, as well as that in patients with preoperative documented gallstones undergoing metabolic surgery. With this practise in place, 5% of the patients in our study required postoperative cholecystectomy.…”

Section: Aspiration Pneumonia 1 Pneumoniamentioning

confidence: 99%

Baseline patient profiling and three-year outcome data after metabolic surgery at a South African centre of excellence

Merwe

Fetter²,

Naidoo³

et al. 2015

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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The bariatric team at Waterfall City Hospital in Gauteng has performed 820 metabolic surgeries under the guidance of an extended team, and with comprehensive recordkeeping. Baseline profiling on more than 50 variables afforded insight into patients undergoing surgery. The available outcome data over three years were comparable with those in the documented literature. The attempted weight loss period prior to agreeing to surgery was 16-18 years. Weight loss in the overall cohort was 29% at three years, with a two-year outcome as follows: diabetes mellitus remission of 81.6% in males and 83.1% in females, full and part-hypertension resolution of 84.8% in males and 74.6% in females, hyperlipidaemia on no treatment of 76.8% in males and 72.1% in females, and sleep apnoea of 75.5% in males and 76.8% in females. Separating out the diabetic group indicated a diabetes mellitus remission of 73.9% in males and 75.1% in females at one year. Improvement in the components of metabolic syndrome was demonstrated in the total cohort. There was an worse profile and higher risk in the male patients. Similarly, higher risk was recorded in the biliopancreatic diversion-duodenal switch cohort, and there was a higher percentage of elected diabetic patients. A wide range of revision surgery was performed, with a higher complication rate (20%) experienced compared to that recorded with the primary surgeries. The morbidity data were separated into medical and surgical morbidity. Major medical morbidity was documented at 5.6% and surgical morbidity at 3.9%. Surgical morbidity in the first 250 cases was reported to be 6% vs. 2.7% in the last 570 cases. Mortality for the cohort was noted to be 0.1%.

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Is Prophylactic Cholecystectomy Useful in Obese Patients Undergoing Gastric Bypass?

Abstract: Based on these results and given the absence of morbidity, we believe that prophylactic cholecystectomy is suitable during open gastric bypass.

Cited by 43 publications

References 14 publications

Predictors of Gallstone Formation in Morbidly Obese Patients after Bariatric Surgery: A Retrospective Observational Study

Predictors of Gallstone Formation in Morbidly Obese Patients after Bariatric Surgery: A Retrospective Observational Study

The evaluation of gallstone formation in patients undergoing Roux-en -Y gastric bypass due to morbid obesity

Baseline patient profiling and three-year outcome data after metabolic surgery at a South African centre of excellence

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