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