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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)3106-3111
Number of pages6
JournalSurgical endoscopy
Volume29
Issue number11
DOIs
StatePublished - Nov 1 2015

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Keywords

  • Concomitant cholecystectomy
  • Gallbladder disease after Roux-en-Y
  • Gastric bypass outcomes

ASJC Scopus subject areas

  • Surgery

Cite this

Weiss, A. C., Inui, T., Parina, R., Coker, A. M., Jacobsen, G., Horgan, S., Talamini, M., Chang, D. C., & Sandler, B. (2015). Concomitant cholecystectomy should be routinely performed with laparoscopic Roux-en-Y gastric bypass. Surgical endoscopy, 29(11), 3106-3111. https://doi.org/10.1007/s00464-014-4033-5