Skip to main content
Top
Published in: Obesity Surgery 11/2013

01-11-2013 | Original Contributions

Does Concomitant Cholecystectomy at Time of Roux-en-Y Gastric Bypass Impact Adverse Operative Outcomes?

Authors: Robert B. Dorman, Wei Zhong, Anasooya A. Abraham, Sayeed Ikramuddin, Waddah B. Al-Refaie, Daniel B. Leslie, Elizabeth B. Habermann

Published in: Obesity Surgery | Issue 11/2013

Login to get access

Abstract

Background

We hypothesized that patients undergoing Roux-en-Y gastric bypass (RYGB) with concomitant cholecystectomy (RYGB + C) would be at greater risk for adverse events compared to patients undergoing RYGB alone.

Methods

Patients who underwent a RYGB were identified in the 2005–2009 American College of Surgeons National Surgical Quality Improvement Program Database. Multivariate logistic regression with adjustment for confounding variables was utilized to identify risk factors for mortality at 30 days, major adverse events, and prolonged length of stay (PLOS).

Results

We identified 32,946 patients who underwent RYGB; of these, 1,731 (5.2 %) underwent RYGB + C. Overall, RYGB + C was a risk factor for predicting major adverse events following laparoscopic but not open procedures. Regardless of approach, PLOS was more common among RYGB + C patients following adjustment. Overall mortality at 30 days was low and did not vary with concomitant cholecystectomy following adjustment.

Conclusions

The risk for major adverse events is significantly greater for RYGB + C patients following laparoscopic procedures, and the risk for PLOS is greater for RYGB + C patients following both open and laparoscopic procedures. The short-term risks identified in this study can assist in decision-making when considering concomitant cholecystectomy at the time of RYGB.
Literature
1.
2.
go back to reference Al-Azzawi HH, Nakeeb A, Saxena R, et al. Cholecystosteatosis: an explanation for increased cholecystectomy rates. J Gastrointest Surg. 2007;11:835–42.PubMedCrossRef Al-Azzawi HH, Nakeeb A, Saxena R, et al. Cholecystosteatosis: an explanation for increased cholecystectomy rates. J Gastrointest Surg. 2007;11:835–42.PubMedCrossRef
3.
go back to reference Bingener J, Richards ML, Schwesinger WH, et al. Laparoscopic cholecystectomy for biliary dyskinesia: correlation of preoperative cholecystokinin cholescintigraphy results with postoperative outcome. Surg Endosc. 2004;18:802–6.PubMedCrossRef Bingener J, Richards ML, Schwesinger WH, et al. Laparoscopic cholecystectomy for biliary dyskinesia: correlation of preoperative cholecystokinin cholescintigraphy results with postoperative outcome. Surg Endosc. 2004;18:802–6.PubMedCrossRef
4.
go back to reference Tucker ON, Fajnwaks P, Szomstein S, et al. Is concomitant cholecystectomy necessary in obese patients undergoing laparoscopic gastric bypass surgery? Surg Endosc. 2008;22:2450–4.PubMedCrossRef Tucker ON, Fajnwaks P, Szomstein S, et al. Is concomitant cholecystectomy necessary in obese patients undergoing laparoscopic gastric bypass surgery? Surg Endosc. 2008;22:2450–4.PubMedCrossRef
5.
go back to reference Taylor J, Leitman IM, Horowitz M. Is routine cholecystectomy necessary at the time of Roux-en-Y gastric bypass? Obes Surg. 2006;16:759–61.PubMedCrossRef Taylor J, Leitman IM, Horowitz M. Is routine cholecystectomy necessary at the time of Roux-en-Y gastric bypass? Obes Surg. 2006;16:759–61.PubMedCrossRef
6.
go back to reference Worni M, Guller U, Shah A, et al. Cholecystectomy concomitant with laparoscopic gastric bypass: a trend analysis of the Nationwide Inpatient Sample from 2001 to 2008. Obes Surg. 2012;22(2):220–9.PubMedCrossRef Worni M, Guller U, Shah A, et al. Cholecystectomy concomitant with laparoscopic gastric bypass: a trend analysis of the Nationwide Inpatient Sample from 2001 to 2008. Obes Surg. 2012;22(2):220–9.PubMedCrossRef
7.
go back to reference Al-Refaie WB, Parsons HM, Habermann EB, et al. Operative outcomes beyond 30-day mortality: colorectal cancer surgery in the oldest old. Ann Surg. 2011;253(5):947–52.PubMedCrossRef Al-Refaie WB, Parsons HM, Habermann EB, et al. Operative outcomes beyond 30-day mortality: colorectal cancer surgery in the oldest old. Ann Surg. 2011;253(5):947–52.PubMedCrossRef
8.
go back to reference Dorman RB, Abraham AA, Al-Refaie WB, et al. Bariatric surgery outcomes in the elderly: an ACS NSQIP Study. J Gastrointest Surg. 2012;16(1):35–44.PubMedCrossRef Dorman RB, Abraham AA, Al-Refaie WB, et al. Bariatric surgery outcomes in the elderly: an ACS NSQIP Study. J Gastrointest Surg. 2012;16(1):35–44.PubMedCrossRef
9.
go back to reference Borja-Cacho D, Parsons HM, Habermann EB, et al. Assessment of ACS NSQIP’s predictive ability for adverse events after major cancer surgery. Ann Surg Oncol. 2010;17(9):2274–82.PubMedCrossRef Borja-Cacho D, Parsons HM, Habermann EB, et al. Assessment of ACS NSQIP’s predictive ability for adverse events after major cancer surgery. Ann Surg Oncol. 2010;17(9):2274–82.PubMedCrossRef
10.
go back to reference Kim JJ, Schirmer B. Safety and efficacy of simultaneous cholecystectomy at Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5(1):48–53.PubMedCrossRef Kim JJ, Schirmer B. Safety and efficacy of simultaneous cholecystectomy at Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5(1):48–53.PubMedCrossRef
11.
go back to reference Nougou A, Suter M. Almost routine prophylactic cholecystectomy during laparoscopic gastric bypass is safe. Obes Surg. 2008;18(5):535–9.PubMedCrossRef Nougou A, Suter M. Almost routine prophylactic cholecystectomy during laparoscopic gastric bypass is safe. Obes Surg. 2008;18(5):535–9.PubMedCrossRef
12.
go back to reference Ahmed AR, O’Malley W, Johnson J, et al. Cholecystectomy during laparoscopic gastric bypass has no effect on duration of hospital stay. Obes Surg. 2007;17(8):1075–9.PubMedCrossRef Ahmed AR, O’Malley W, Johnson J, et al. Cholecystectomy during laparoscopic gastric bypass has no effect on duration of hospital stay. Obes Surg. 2007;17(8):1075–9.PubMedCrossRef
13.
go back to reference Hamad GG, Ikramuddin S, Gourash WF, et al. Elective cholecystectomy during laparoscopic Roux-en-Y gastric bypass: is it worth the wait? Obes Surg. 2003;13(1):76–81.PubMedCrossRef Hamad GG, Ikramuddin S, Gourash WF, et al. Elective cholecystectomy during laparoscopic Roux-en-Y gastric bypass: is it worth the wait? Obes Surg. 2003;13(1):76–81.PubMedCrossRef
14.
go back to reference Caruana JA, McCabe MN, Smith AD, et al. Incidence of symptomatic gallstones after gastric bypass: is prophylactic treatment really necessary? Surg Obes Relat Dis. 2005;1(6):564–8.PubMedCrossRef Caruana JA, McCabe MN, Smith AD, et al. Incidence of symptomatic gallstones after gastric bypass: is prophylactic treatment really necessary? Surg Obes Relat Dis. 2005;1(6):564–8.PubMedCrossRef
15.
go back to reference Swartz DE, Felix EL. Elective cholecystectomy after Roux-en-Y gastric bypass: why should asymptomatic gallstones be treated differently in morbidly obese patients? Surg Obes Relat Dis. 2005;1(6):555–60.PubMedCrossRef Swartz DE, Felix EL. Elective cholecystectomy after Roux-en-Y gastric bypass: why should asymptomatic gallstones be treated differently in morbidly obese patients? Surg Obes Relat Dis. 2005;1(6):555–60.PubMedCrossRef
16.
go back to reference Quesada BM, Kohan G, Roff HE, et al. Management of gallstones and gallbladder disease in patients undergoing gastric bypass. World J Gastroenterol. 2010;16(17):2075–9.PubMedCrossRef Quesada BM, Kohan G, Roff HE, et al. Management of gallstones and gallbladder disease in patients undergoing gastric bypass. World J Gastroenterol. 2010;16(17):2075–9.PubMedCrossRef
17.
go back to reference D’Hondt M, Sergeant G, Deylgat B, et al. Prophylactic cholecystectomy, a mandatory step in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass? J Gastrointest Surg. 2011;15(9):1532–6.PubMedCrossRef D’Hondt M, Sergeant G, Deylgat B, et al. Prophylactic cholecystectomy, a mandatory step in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass? J Gastrointest Surg. 2011;15(9):1532–6.PubMedCrossRef
18.
go back to reference Smith MD, Patterson E, Wahed AS, et al. Relationship between surgeon volume and adverse outcomes after RYGB in Longitudinal Assessment of Bariatric Surgery (LABS) study. Surg Obes Relat Dis. 2010;6(2):118–25.PubMedCrossRef Smith MD, Patterson E, Wahed AS, et al. Relationship between surgeon volume and adverse outcomes after RYGB in Longitudinal Assessment of Bariatric Surgery (LABS) study. Surg Obes Relat Dis. 2010;6(2):118–25.PubMedCrossRef
19.
go back to reference Hollenbeak CS, Rogers AM, Barrus B, et al. Surgical volume impacts bariatric surgery mortality: a case for centers of excellence. Surgery. 2008;144(5):736–43.PubMedCrossRef Hollenbeak CS, Rogers AM, Barrus B, et al. Surgical volume impacts bariatric surgery mortality: a case for centers of excellence. Surgery. 2008;144(5):736–43.PubMedCrossRef
20.
go back to reference Birkmeyer NJ, Dimick JB, Share D, et al. Michigan Bariatric Surgery Collaborative. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010;304(4):435–42.PubMedCrossRef Birkmeyer NJ, Dimick JB, Share D, et al. Michigan Bariatric Surgery Collaborative. Hospital complication rates with bariatric surgery in Michigan. JAMA. 2010;304(4):435–42.PubMedCrossRef
Metadata
Title
Does Concomitant Cholecystectomy at Time of Roux-en-Y Gastric Bypass Impact Adverse Operative Outcomes?
Authors
Robert B. Dorman
Wei Zhong
Anasooya A. Abraham
Sayeed Ikramuddin
Waddah B. Al-Refaie
Daniel B. Leslie
Elizabeth B. Habermann
Publication date
01-11-2013
Publisher
Springer US
Published in
Obesity Surgery / Issue 11/2013
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-013-1001-4

Other articles of this Issue 11/2013

Obesity Surgery 11/2013 Go to the issue