COMMENTARY

Cholecystectomy: Before or After Gastric Bypass?

Albert B. Lowenfels, MD

Disclosures

February 16, 2018

For patients with gallstones who are undergoing bariatric surgery, when is the best time to perform cholecystectomy? In a study from Sweden, published in the British Journal of Surgery,[1] the authors combined patient data from separate gallstone and obesity databases into three groups: cholecystectomy after bypass (n =1133); cholecystectomy before bypass (n = 982); and simultaneous cholecystectomy and bypass (n = 152). Compared with pre-bypass cholecystectomy, perioperative or postoperative cholecystectomy resulted in an increase of any complication (odds ratio = 1.37, P = .006).

Viewpoint

This study, based on information contained in two Swedish databases, provides information on the preferred timing of cholecystectomy in morbidly obese patients undergoing Roux-en-Y gastric bypass. Results strongly favor performing cholecystectomy as a separate procedure, performed prior to the bypass procedure. Twenty-two percent of patients undergoing simultaneous procedures had an open operation rather than a laparoscopic procedure, compared with less than 5% of patients receiving an open operation using a staged approach.

An additional drawback of the combined, simultaneous approach was that it added about an hour to the procedure. This report focuses on the timing of cholecystectomy, but it does not provide information on criteria for selection of patients who need a cholecystectomy. In this study, cholecystectomy was performed in 6.5% of patients receiving bypass surgery.

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