TY - JOUR
T1 - Concomitant cholecystectomy should be routinely performed with laparoscopic Roux-en-Y gastric bypass
AU - Weiss, Anna C.
AU - Inui, Tazo
AU - Parina, Ralitza
AU - Coker, Alisa M.
AU - Jacobsen, Garth
AU - Horgan, Santiago
AU - Talamini, Mark
AU - Chang, David C.
AU - Sandler, Bryan
PY - 2015/11/1
Y1 - 2015/11/1
N2 - 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.
AB - 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.
KW - Concomitant cholecystectomy
KW - Gallbladder disease after Roux-en-Y
KW - Gastric bypass outcomes
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U2 - 10.1007/s00464-014-4033-5
DO - 10.1007/s00464-014-4033-5
M3 - Article
C2 - 25515986
AN - SCOPUS:84944316382
SN - 0930-2794
VL - 29
SP - 3106
EP - 3111
JO - Surgical Endoscopy
JF - Surgical Endoscopy
IS - 11
ER -