Routine cholecystectomy during laparoscopic biliopancreatic diversion with duodenal switch is not necessary

Bardaro, Sergio Jose; Gagner, Michel; Consten, Esther; Inabnet, William Barry; Herron, Daniel; Dakin, Gregory; Pomp, Alfons

doi:10.1016/j.soard.2007.05.007

« Previous Next »Surgery for Obesity and Related Diseases
Volume 3, Issue 5 , Pages 549-553, September 2007

Routine cholecystectomy during laparoscopic biliopancreatic diversion with duodenal switch is not necessary

Presented in the Plenary Session of the 21st Annual Meeting of the American Society for Bariatric Surgery, San Diego, California, June 12–18, 2004

Sergio Jose Bardaro, M.D.
- New York-Presbyterian Hospital, New York, New York
- Weill Medical College of Cornell University, New York, New York
Michel Gagner, M.D., F.A.C.S., F.R.C.S.C.
- New York-Presbyterian Hospital, New York, New York
- Weill Medical College of Cornell University, New York, New York
- Reprint requests: Michel Gagner, M.D., F.A.C.S., F.R.C.S.C., Department of Surgery, Division of Laparoscopic and Bariatric Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, 525 East 68th Street, Mailbox 294, New York, NY 10021.
Esther Consten, M.D.
- New York-Presbyterian Hospital, New York, New York
- Weill Medical College of Cornell University, New York, New York
William Barry Inabnet, M.D.
- New York-Presbyterian Hospital, New York, New York
- Columbia University College of Physicians and Surgeons, New York, New York
Daniel Herron, M.D.
- Mount Sinai School of Medicine, New York, New York
Gregory Dakin, M.D.
- New York-Presbyterian Hospital, New York, New York
- Weill Medical College of Cornell University, New York, New York
Alfons Pomp, M.D., F.A.C.S., F.R.C.S.C.
- New York-Presbyterian Hospital, New York, New York
- Weill Medical College of Cornell University, New York, New York

Received 12 July 2006; received in revised form 9 May 2007; accepted 12 May 2007.

Abstract

Background

Similar to gastric bypass patients, a regimen of ursodeoxycholic acid in the immediate postoperative period might obviate the need for routine cholecystectomy. Routine cholecystectomy has been recommended for patients who undergo biliopancreatic diversion (BPD), because of the high prevalence of gallstones in the obese patient and presumed development of gallstones postoperatively. We have considered elective cholecystectomy only if gallbladder disease were present. The aim of this study was to assess the need for cholecystectomy in the postoperative period in such patients.

Methods

In this retrospective study, the data from 219 patients who had undergone BPD with duodenal switch (BPD/DS), from January 1999 to January 2003, were analyzed. We performed a 150-cm alimentary limb and 100-cm common channel BPD/DS. The patients received 600 mg ursodeoxycholic acid orally daily for 6 months. The following data were recorded: demographics, medical history, medication, weight loss, diagnostic evaluation, and operative and pathologic data.

Results

Of the 219 patients who underwent surgery, 59 were men (26.9%) and 160 women were (73.1%) (mean age 41.7 years, mean body mass index 55.7 kg/m²). The mean follow-up was 30 months (range 12–48). Of the 219 patients, 57 (19.6%) underwent cholecystectomy: 28 (12.7%) preoperatively, 10 (4.5%) simultaneously, and 19 (8.7%) postoperatively. Simultaneous cholecystectomy was performed when the patient had a history of colic episodes with gallbladder disease (disclosed by preoperative ultrasonography). The postoperative cholecystectomy pathology reports showed cholecystitis in only 7 patients.

Conclusion

The results of our study have shown that the incidence of postoperative cholecystectomy in BPD/DS patients is low, and cholecystitis is rare. Routine cholecystectomy in BPD/DS patients is no longer recommended.

Keywords: Biliopancreatic diversion with duodenal switch, Cholecystectomy, Gallbladder disease, Bariatric surgery, Gallstone formation, Ursodeoxycholic acid