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‘GASTRIC BYPASS WITH OR WITHOUT CHOLECYSTECTOMY?’ A 10 YEAR PERSPECTIVE’

Robert M Cunningham, MD, Jason E Kuhn, DO, Marcus Fluck, James T Dove, Katherine T Jones, Ryan D Horsley, MD, Jon D Gabrielsen, MD, Anthony T Petrick, MD, David M Parker, MD. Geisinger

Introduction: The aim of the study was to evaluate outcomes of selective concurrent cholecystectomy and long term biliary outcomes after Roux-en-Y Gastric Bypass (RYGB).   

Methods: We performed a retrospective analysis of patients who underwent Laparoscopic RYGB (LRYGB) between 2008 and 2018. Chi-square, Fisher’s exact, or Wilcoxon rank-sum tests were used to compare outcomes.

Results: 3004 patients underwent a RYGB (LRYGB n= 2453, open RYGB n= 533).  At time of review, 54.7% (n= 1643) of patients had undergone a cholecystectomy.  31.1% of patients (n=933) had a cholecystectomy prior to RYGB, 16.9% (n=509) had a concurrent cholecystectomy and 51.9% (n= 1562) did not have a cholecystectomy.  After LRYGB, 12.9% (n=202) underwent an interval cholecystectomy. Of those who underwent LRYGB, 29.9% (n=735) had a prior cholecystectomy.  Those who underwent concurrent cholecystectomy/ LRYGB (n=328) were compared with LRYGB alone (n=1231). The concurrent cholecystectomy group were significantly older, higher percentage of females, higher preoperative BMI, higher Charlson Comorbidity index and a higher medication count. The two groups demonstrated no significant difference in BMI nadir, length of stay, complications or mortality.

Conclusions: The study supports that a higher percentage of bariatric patients will undergo cholecystectomy. Long-term follow-up demonstrates a higher rate of interval cholecystectomy than previously reported.   Concurrent cholecystectomy can be performed safely without an increase in length of stay, complications or 30-day mortality.

Table 1

Laparoscopic RYGB versus combined RYGB/cholecystectomy
  LRYGB only Concurrent cholecystectomy  
  n=1231(%) n=328(%) p value
Female 910(73.9) 266(81.1) 0.008
Age,years 43.9(11.5) 45.9(11.2) 0.008
BMI,initial 47.0(7.7) 48.1(8.3) 0.032
BMI,nadir 31.2(7.3) 31.3(7.6) 0.948
%BMI Change, nadir -33.3 -34.6 0.117
Comorbidity Score 4.4(2.2) 4.8(2.4) 0.025
Medications 5.4(3.5) 5.9(3.6) 0.0279
Length of stay, days 1.7(1.2) 1.8(1.1) 0.116
Readmission, 30 Day 126(10.2) 43(13.1) 0.1368
Any reintervention 40(3.3) 14(4.3) 0.370
Minor Complication 89(7.2) 31(9.5) 0.180
Major Complication 26(2.1) 12(3.7) 0.107
Mortality, 30 Day 1(0.1) 1(0.3) 0.377

Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94441

Program Number: P069

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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