2005 Abstracts: Cholecystectomy or Not? That Is the Question:Analysis of Gallbladder Pathology in Bariatric Surgery Patients
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Cholecystectomy or Not? That Is the Question:Analysis of Gallbladder Pathology in Bariatric Surgery Patients
Ana M. Parsee, Krista L. Haines, Scott F. Gallagher, Michel M. Murr, University of South Florida Health Science Center, Tampa, FL
Introduction: Surgically induced rapid weight loss and obesity are risk factors for cholelithiasis. Fifty percent of patients who undergo bariatric surgery without a concomitant cholecystectomy develop symptomatic gallbladder disease within 6 months post-operatively. Hence many surgeons undertake routine cholecystectomy at the time of bariatric surgery. Moreover, a recent survey showed that 30% of surgeons undertaking Roux-en Y gastric bypass (RYGB) for obesity routinely remove normal appearing gallbladders.
Aim: To determine the incidence of significant gallbladder pathology in patients undergoing bariatric surgery. Methods: The histopathology reports of 660 consecutive patients who underwent RYGB were reviewed. All patients without the prior surgical history, underwent routine cholecystectomy during RYGB. Pathologic diagnoses were: chronic cholecystitis, cholesterolosis, cholelithiasis and acute cholecystitis. Data are mean ± SEM. Results: 660 patients (age: 43± 0.4 yrs, BMI: 51± 0.4 Kg/m2) underwent 432 open and 228 laparoscopic RYGB. 491 patients (414 women, 77 men) underwent cholecystectomy at the time of surgery while 169 had prior cholcystectomy. Pathological findings in 354 patients were: chronic cholecystitis (49%), cholesterolosis (31%), cholelithiasis (20%), and acute cholecystitis (1 patient). There were no histopathological changes in 139 specimens. One patient developed a bile leak after laparoscopic RYGB that resolved spontaneously. No other complications were attributable to routine cholecystectomy. Conclusion: 71% of gall bladders routinely removed during RYGB exhibited histopathological changes. The high incidence of histopathological changes, the technical ease and negligible morbidity of concomitant cholecystectomy justify routine cholecystectomy during RYGB.
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