Asymptomatic Cholelithiasis and Bariatric Surgery: a Comprehensive Long-Term Analysis of the Risks of Biliary Disease in
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Asymptomatic Cholelithiasis and Bariatric Surgery: a Comprehensive Long-Term Analysis of the Risks of Biliary Disease in Patients Undergoing Primary Roux-en-Y Gastric Bypass Robert M. Cunningham 1 & Katherine T. Jones 1 & Jason E. Kuhn 1 & James T. Dove 2 & Ryan D. Horsley 1 & Mustapha Daouadi 1 & Jon D. Gabrielsen 1 & Anthony T. Petrick 1 & David M. Parker 1 Received: 19 August 2020 / Revised: 10 November 2020 / Accepted: 11 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Currently, there is little consensus on management of the in situ gallbladder of patients undergoing gastric bypass. Our aim was to evaluate outcomes of selective concomitant cholecystectomy (CCY) and long-term biliary outcomes after Roux-en-Y gastric bypass (RYGB). Materials and Methods We performed a retrospective analysis of patients undergoing laparoscopic RYGB (LRYGB) between 2008 and 2018. Chi-square, Fisher’s exact, or Wilcoxon rank-sum tests were used to compare outcomes. Concomitant CCY was performed on a selective basis. Results Three thousand and four patients underwent a RYGB (LRYGB n = 2458, open RYGB n = 546). Fifty-two percent (n = 1670) of patients had undergone CCY at any stage. Thirty-one percent of patients (n = 933) had CCY prior to RYGB, 13% (n = 403) had a concomitant CCY and 13% (n = 214) of the remainder required interval CCY. In the LRYGB subgroup, 29.9% (n = 735) had a prior CCY; 12.9% (n = 202) of those with an in situ gallbladder required interval CCY. Those who underwent concomitant CCY/ LRYGB (n = 328) were compared with LRYGB alone (n = 1231). The concomitant CCY group was significantly older and had higher percentage of females, higher preoperative BMI, higher Charlson Comorbidity Index, and a higher medication count. There was no significant difference in BMI nadir, length of stay, complications, or mortality. Interval CCY had a higher incidence of CCYrelated complications. Conclusion Our study suggests a higher percentage of bariatric patients with in situ gallbladders will undergo interval CCY than documented in recently published guidelines. Concomitant CCY can be performed without an increase in length of stay or complications. Interval CCY may be associated with a higher complication rate. Keywords Gastric bypass . Bariatric . Asymptomatic cholelithiasis . Cholecystectomy . Biliary . Complications . MBSAQIP
Introduction The exponential rise in adult and pediatric obesity rates is rapidly becoming the most pressing public health issue of our time [1]. Recent estimates from the CDC indicate that 39.8% of the US adult population is suffering from obesity [2]. Bariatric surgery is currently the most effective therapy to * David M. Parker [email protected] 1
Division of Bariatric and Foregut Surgery, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA 17822, USA
2
Department of General Surgery, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA 17822, USA
treat obesity and its many sequelae [3]. Though laparo
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