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Concomitant cholecystectomy should be routinely performed with laparoscopic Roux-en-Y gastric bypass

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Abstract

Introduction

As the popularity of a laparoscopic Roux-en-Y Gastric Bypass (RYGB) surpassed that of an open approach, practice of concomitant cholecystectomy declined. Low rates of gallbladder disease following RYGB and high complication rates of concomitant cholecystectomy have been published, but these population-based studies have lacked long-term outcomes and survival data.

Study design

The California Office of Statewide Health Planning and Development longitudinal database was queried for patients who underwent RYGB with or without cholecystectomy between 1995 and 2009. Additionally, patients who underwent cholecystectomy after RYGB were compared to all cholecystectomy patients. Primary outcome was survival; secondary long-term outcomes included cholangitis, common duct stones, dumping syndrome, metabolic derangements, ventral hernia, any hernia, marginal ulcers, and reoperation. Cox proportional hazard analysis was performed to determine adjusted survival and outcomes.

Results

Of 134,584 RYGB patients, 21,022 underwent concomitant cholecystectomy. Concomitant cholecystectomy improved both survival (HR[95 % CI] 0.51[.48–.54]) and long-term outcomes (HR 0.84[.77–.91]). Incidence of gallbladder disease following RYGB was 6.8 and 15.2 % at 1 and 5 years. In subsequent analysis of 829,333 cholecystectomy patients, 7,099 underwent prior RYGB with higher risk of conversion to open (HR 1.58[1.41–1.78]), post-operative complication (HR 1.47[1.36–1.6]) and death (HR 1.32[1.17–1.5]).

Conclusions

Concomitant cholecystectomy is safe for RYGB patients. Given high rates of gallbladder disease and increased risk when cholecystectomy is performed following RYGB, cholecystectomy should be considered at the time of RYGB.

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Disclosures

Dr. Bryan Sandler is a consultant for ValenTx, inc., and a speaker for Ethicon and Gore. Drs. Anna C. Weiss, Tazo Inui, Alisa M. Coker, David C. Chang, Mark Talamini, Santiago Horgan, and Ralitza Parina have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, University of California, San Diego, 200 W. Arbor Drive, MC 8402, San Diego, CA, 92103, USA

    Anna C. Weiss, Tazo Inui, Ralitza Parina, Alisa M. Coker, Garth Jacobsen, Santiago Horgan, Mark Talamini, David C. Chang & Bryan Sandler

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  1. Anna C. Weiss
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  2. Tazo Inui
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Correspondence to Anna C. Weiss.

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Weiss, A.C., Inui, T., Parina, R. et al. Concomitant cholecystectomy should be routinely performed with laparoscopic Roux-en-Y gastric bypass. Surg Endosc 29, 3106–3111 (2015). https://doi.org/10.1007/s00464-014-4033-5

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  • DOI: https://doi.org/10.1007/s00464-014-4033-5

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