Expectant management of the asymptomatic gallbladder at Roux-en-Y gastric bypass

被引:61
作者
Portenier, Dana D. [1 ]
Grant, John P. [1 ]
Blackwood, Hilary S. [1 ]
Pryor, Aurora [1 ]
McMahon, Ross L. [1 ]
DeMaria, Eric [1 ]
机构
[1] Duke Univ, Med Ctr, Dept Surg, Durham, NC 27704 USA
关键词
Gallbladder; Roux-en-Y gastric bypass; Ultrasonography; Cholecystectomy;
D O I
10.1016/j.soard.2007.02.006
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: Because of the claim that about one third of patients develop gallstones within 6 months of Roux-en-Y gastric bypass (RYGB). many have recommended preoperative ultrasonography for all patients and/or prophylactic cholecystectomy (CCY). or ursodiol to prevent stone formation. Methods: Prospective data were collected from 1391 consecutive patients followed LIP for :6 months after RYGB (2000-2005) to assess Our practice of not routinely removing the gallbladder and not administering ursodiol. Results: Of the 1391 patients, 334 (24%) had undergone CCY before RYGB. Of the remaining 1057 asymptomatic patients, 516 had undergone preoperative ultrasonography. Stones were identified in 99 (19%). Sludge in 5 (0.97%). and polyps in 6 (1.1%). Of the 984 patients with gallbladders left in situ after RYGB. only 80 (8.1%) became symptomatic and required delayed CCY. The average excess weight loss at the delayed CCY was 65%. The risk Of undergoing delayed CCY seemed to be restricted to the first 29 months after RYGB, because none of 165 patients followed tip for 30-144 months required CCY. Conclusion: Although CCY Should be performed whenever symptoms mandate. the value of routine preoperative Ultrasonography and CCY was not apparent front the results of our study. Waiting Until symptoms develop might simplify the operative procedure because of the significant weight loss that should have Occurred after RYGB. Using an expectant approach. most patients Undergoing RYGB will not require CCY. (Surg Obes Relat Dis 2007:3:476-479.) (C) 2007 American Society for Bariatric Surgery. All rights reserved.
引用
收藏
页码:476 / 479
页数:4
相关论文
共 19 条
[1]   GALLBLADDER-DISEASE IN THE MORBIDLY OBESE [J].
AMARAL, JF ;
THOMPSON, WR .
AMERICAN JOURNAL OF SURGERY, 1985, 149 (04) :551-557
[2]  
DEITEL M, 1987, SURG GYNECOL OBSTET, V164, P549
[3]   Gallbladder pathology in morbid obesity [J].
Dittrick, GW ;
Thompson, JS ;
Campos, D ;
Bremers, D ;
Sudan, D .
OBESITY SURGERY, 2005, 15 (02) :238-242
[4]   CONTRIBUTIONS OF OBESITY AND WEIGHT-LOSS TO GALLSTONE DISEASE [J].
EVERHART, JE .
ANNALS OF INTERNAL MEDICINE, 1993, 119 (10) :1029-1035
[5]   Overweight and obesity in the United States: prevalence and trends, 1960-1994 [J].
Flegal, KM ;
Carroll, MD ;
Kuczmarski, RJ ;
Johnson, CL .
INTERNATIONAL JOURNAL OF OBESITY, 1998, 22 (01) :39-47
[6]   Prophylactic cholecystectomy with gastric bypass operation: Incidence of gallbladder disease [J].
Fobi, M ;
Lee, H ;
Igwe, D ;
Felahy, B ;
James, E ;
Stanczyk, M ;
Fobi, N .
OBESITY SURGERY, 2002, 12 (03) :350-353
[7]   Elective cholecystectomy during laparoscopic Roux-en-Y gastric bypass: Is it worth the wait? [J].
Hamad, GG ;
Ikramuddin, S ;
Gourash, WF ;
Schauer, PR .
OBESITY SURGERY, 2003, 13 (01) :76-81
[8]   THERAPEUTIC FASTING IN MORBID OBESITY - LONG-TERM FOLLOW-UP [J].
JOHNSON, D ;
DRENICK, EJ .
ARCHIVES OF INTERNAL MEDICINE, 1977, 137 (10) :1381-1382
[9]   GALLSTONE FORMATION DURING WEIGHT-REDUCTION DIETING [J].
LIDDLE, RA ;
GOLDSTEIN, RB ;
SAXTON, J .
ARCHIVES OF INTERNAL MEDICINE, 1989, 149 (08) :1750-1753
[10]   Prophylactic cholecystectomy with open gastric bypass operation [J].
Liem, RK ;
Niloff, PH .
OBESITY SURGERY, 2004, 14 (06) :763-765