Preventative cholecystectomy unnecessary at the time of Roux-en-Y gastric bypass

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Preventative cholecystectomy for a normal gallbladder is not necessary at the time of Roux-en-Y gastric bypass.

According to recent research from the United States, “Morbid obesity is associated with an increased incidence of gallstones. Rapid weight loss, as occurs after Roux-en-Y gastric bypass (RYGBP) may also increase gallstone development. Standard surgical treatments for gallbladder disease and its complications might be more difficult following RYGBP.

Controversy still exists whether prophylactic cholecystectomy is indicated at the time of RYGBP.”

"Retrospective analysis was performed on a database of 535 patients who underwent RYGBP for morbid obesity during a 5.5-year period. Patients were followed and medical records were reviewed. Ursodeoxycholic acid was not prescribed following surgery,” wrote J. Taylor and colleagues, Beth Israel Medical Center.

The results revealed, “8% of patients had had cholecystectomy before the RYGBP.

75 of 492 patients (15%) were found to have gallstones at RYGBP, and cholecystectomy was performed at the same time. 3 of these patients had bile leaks but only I required further intervention (percutaneous transhepatic drainage or 3 weeks). Following RYGBP, 14 patients (3%) have required cholecystectomy for symptomatic cholelithiasis in the postoperative period.
All were performed laparoscopically and without complication.”

Investigator concluded, “Symptomatic gallbladder disease after RYGBP has not been frequent. Prophylactic cholecystectomy for a normal gallbladder is not necessary at the time of RYGBP. Patients without biliary tract symptoms may not require routine preoperative sonogram.

The researchers concluded, “If an abnormal gallbladder or gallstones are found at the time of an RYGBP operation, concomitant cholecystectomy should be considered.”

Taylor and colleagues published their study in Obesity Surgery (Is routine cholecystectomy necessary at the time of Roux-en-Y gastric bypass? Obes Surg, 2006;16 (6):759-761).

For additional information, contact I.M. Leitman, Beth Israel Medical Center, Dept. of Surgery, 10 Union Sq E, Suite 2M, New York City, NY 10003, USA.

Publisher contact information for the journal Obesity Surgery is: F DCommunications Inc., 3100 Bayview Avenue, Unit 4, Toronto, Ontario M2N 5L3, Canada.

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