Image: A new study suggests gallbladder removal should be completed before weight-loss surgery (Photo courtesy of iStock).
A new study recommends that cholecystectomy should be performed before, not during or after, Roux-en-Y gastric bypass (RYGB).
Researchers at Örebro University (Sweden), Karolinska University Hospital (Stockholm, Sweden), and other institutions conducted a retrospective study using 2007-2013 data from the Swedish cholecystectomy and endoscopic retrograde cholangiopancreatography register (79,386 patients) and the Scandinavian obesity surgery registry (36,098 patients) to identify the optimal order of gastric bypass surgery and gallbladder surgery, when both procedure are indicated. The main outcomes were complication rates, reoperation rates, and operation times.
The results revealed a higher aggregate complication risk when cholecystectomy was performed after RYGB, rather than before. In addition, a complication after the first procedure independently increased the complication risk of the following procedure, and there was an increased complication risk when cholecystectomy was performed at the same time as RYGB. Simultaneous cholecystectomy and RGYB also added an average 61.7 minutes to total duration of surgery. The study was published on October 18, 2017, in the British Journal of Surgery.
“For patients with obesity and symptomatic gallstone disease, the best strategy complication-wise is to perform cholecystectomy before gastric bypass,” concluded lead author Viktor Wanjura, MD, of the Örebro University department of surgery, and colleagues.
The RYGB procedure has been the gold standard for surgical weight loss intervention for many years. The procedure usually involves laparoscopic minimally invasive surgery to create a stomach pouch from the larger stomach body. A portion of the small intestine is then connected to the stomach pouch, leaving a small opening for food to travel. The result is a sensation of satiety or fullness after eating small meals.
Karolinska University Hospital