Simultaneous/Incidental Cholecystectomy During Gastric/Esophageal Resection: Systematic Analysis of Risks and Benefits

Abstract

Approximately 6% of patients undergoing upper GI surgery are expected to require cholecystectomy during follow-up. Because late cholecystectomies can be performed safely and because the additional calculated morbidity for these operations is lower than the morbidity for simultaneous cholecystectomy, it cannot generally be recommended to remove a normal acalculous gallbladder during upper GI surgery.

The Cholegas Study: safety of prophylactic cholecystectomy during gastrectomy for cancer: preliminary results of a multicentric randomized clinical trial

“…Many studies reported up to 15-25 % incidence 5 years after gastric surgery [1][2][3][4][5][6] with a mean value estimated of 17 % in all studies [1][2][3][4][5][6][7]. Without a specific evidence in the literature, some authors [4,11] recommend to perform a prophylactic cholecystectomy at the time of gastric surgery, while others do not [1,7] and the decision of gallbladder management is left, to date, to each surgeon's preference.…”

“…Due to the lack of specific data and to the presence of contrasting studies, some authors [4,11] recommend to perform a prophylactic cholecystectomy at the time of gastric surgery to avoid complications and impairment of quality of life in surviving patients, while others do not [1,7] and the decision of gallbladder management is left, to date, to each surgeon's preference.…”

“…Although in those patients operated for gastric cancer the 5-year survival rate is less than 50 % in many centers [22,23], more than 90 % of those who will develop calculi, will do it within 2 years after surgery [4]. A recent, well-conducted review article on simultaneous/incidental cholecystectomy during gastro-esophageal resection concluded that only less than 5 % of those patients operated on required a subsequent cholecystectomy for symptoms of cholelithiasis, mostly laparoscopically and with few additional morbidity and mortality [7].…”

“…Many studies reported a three-four fold increased incidence 5 years after gastric surgery (up to 15-25 %) [1][2][3][4][5][6] with an estimated mean value of 17 % in all studies [1][2][3][4][5][6][7]. The underlying mechanism was thought to be related to surgical dissection of the vagus nerve branches and the anatomical gastrointestinal reconstruction [5,[8][9][10], and to the extent of gastrectomy and lymphadenectomy [1,4,[11][12][13].…”

“…Another advantage of prophylactic cholecystectomy was represented by the avoidance of a possible reintervention in case of acute post-operative cholecystitis [7,19,20] and the avoidance of difficult procedures like endoscopic retrograde cholangiography (ERC) in the presence of Roux-en-Y reconstruction.…”