Gallstones and Bariatric Surgery: To Treat or Not to Treat?

Excerpt

The relationship between the gall bladder and morbid obesity, and the strategy used by surgeons for its management can be passive-aggressive. Morbidly obese patients are more likely to develop cholelithiasis. On the other hand, bariatric surgery predisposes to gall bladder stone formation and potentially symptomatic cholelithiasis. The indication for cholecystectomy and its timing in relationship to bariatric surgery is a moving target. In this editorial, we review the current practice and what the literature has to say about it, particularly, what to do with the normal gall bladder and the asymptomatic cholelithiasis in anticipation of bariatric surgery. It seems that, based on the work done by Morais et al. [1], in this issue of the WJS, removing normal gall bladders or performing cholecystectomy for asymptomatic cholelithiasis is not justified when a bariatric procedure is done, a deep sigh of relief for bariatric surgeons. However, the evidence is hardly conclusive, and the debate will continue until prospective randomized trials are carried out. To close the loop on this surgical dilemma, we need to study the proper timing of intervention for one procedure in relationship to the other. Until then, the jury is out. …