Is concomitant cholecystectomy with laparoscopic sleeve gastrectomy safe?

Abstract

Background/Aims: To study the effect of selective concomitant cholecystectomy (SCC) on laparoscopic sleeve gastrectomy (LSG). Materials and Methods: A retrospective case-control study of 16 morbidly obese patients treated with concomitant LSG as the primary bariatric surgery and SCC for proven gallbladder (GB) pathology (Group A) between November 2010 and February 2013 was performed. Randomly selected 32 patients who underwent laparoscopic sleeve gastrectomy was the control group (Group B). Results: A total of 48 patients with a mean age of 35.5±10.7 years were included. Demographic data of groups were similar except that there were more female patients in the Group A (p=0.036). Mean body mass index (kg/ m2) was 51.1±5.6 and 50.9±5.4 in Groups A and B, respectively (p=0.894). The mean operative time for patients with and without cholecystectomy was 157.2±40 and 95.72±6.2 min, respectively (p=0.001). Cholecystectomy resulted in an additional mean operative time of 49.1±27.9 min without any specific complication. There was no statistical difference with regard to overall morbidity (p=0.316) and the length of hospital stay (p=0.528) between groups. Conclusion: Although an increase in operative time may be an important issue, SCC can be performed on all patients with proven GB pathology during LSG without an increase in morbidity or length of hospital stay.

Systematic review of management of gallbladder disease in patients undergoing minimally invasive bariatric surgery

“…In minimally symptomatic patients with proven gallbladder disease on preoperative imaging or intraoperative ultrasound [17][18][19][20], synchronous cholecystectomy at the time of bariatric surgery has been found to be safe. This approach has been supported because of the observed low long-term morbidity in several studies [21][22][23][24], as well as acceptable operative time without increasing the length of hospital stay [25][26][27].…”

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“…(8)(9)(10)(11)(12) There are three strategies for dealing with gallstones in bariatric surgery (1) : selective concomitant cholecystectomy when a preoperative ultrasound shows pathologies like stones or polyps, (2) prophylactic cholecystectomy to all patients, (3) and conventional cholecystectomy if gallstones or symptoms develop after surgery. (13) Concomitant cholecystectomy is limited due to its lengthy operation time and the requirement of additional port placement. The procedure could also be technically demanding.…”

“…The procedure could also be technically demanding. (13) Some prefer concomitant cholecystectomy for patients with positive preoperative or intraoperative ultrasound. (1) While a delay in cholecystectomy is more easily achievable by massive weight loss, the major disadvantage is adhesion, additional cost, morbidity, and possible complications related to gallstone pancreatitis, cholangitis, and cholecystitis.…”

“…In case intraoperative cholangioram is not available or there's injury to the biliary tree, proceeding to LSG is not recommended because the need for ERCP may affect the stable line in the early post-operative period. (13) Prophylactic cholecystectomy in obese patients and after bariatric surgery remains controversial. (3,13,14) Laparoscopic cholecystectomy in morbidly obese patients leads to increased difficulties and morbidity compared to non-obese patients.…”

“…(13) Prophylactic cholecystectomy in obese patients and after bariatric surgery remains controversial. (3,13,14) Laparoscopic cholecystectomy in morbidly obese patients leads to increased difficulties and morbidity compared to non-obese patients. (3,15,16,17) The aim of this study is to find out whether prophylactic concomitant cholecystectomy should be done or not, depending on the incidence of gallstones after LSG.…”