Population-based study of the need for cholecystectomy after obesity surgery

Östlund, Magdalena Plecka; Wenger, Urs; Mattsson, Fredrik; Ebrahim, Fereshte; Botha, Abrie; Lagergren, Jesper

doi:10.1002/bjs.8701

Cited by 39 publications

(12 citation statements)

References 21 publications

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“…Furthermore, LCBDE and transcystic stone extraction can be performed in patients with a Roux-en-Y shunt ( 10 ). With the increasing numbers of patients undergoing obesity surgery, this has become an increasing challenge ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Common Bile Duct Exploration: 9 Years Experience from a Single Center

2016

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IntroductionThe aim of the study was to evaluate the safety and feasibility of laparoscopic common bile duct exploration (LCBDE) through cholangiotomy with T-tube placement in one séance for common bile duct stones (CBDS).MethodsBetween January 2005 and December 2010, a total of 99 patients with CBDS stones undergoing LCBDE with T-tube insertion at Enköping Hospital, Sweden, were registered prospectively. All patients were followed up by review of the patient records according to a standardized protocol.ResultsNo severe intraoperative complications were registered. Four procedures required conversion to open cholecystectomy due to impacted stones or technical difficulty. The mean operative time was 194 min [(SD) 57 min]. The mean postoperative hospital stay was 4.8 days, SD 2.4 days. At secondary cholangiography, 2 (2%) retained stones were found. Two (2%) patients had minor bile leakage, which resolved spontaneously. None of the patients experienced biliary peritonitis, biliary fistula, pancreatitis, or cholangitis. No death within 30 days after surgery was seen. No patient was readmitted with clinical signs of stricture.ConclusionIf performed by a surgeon familiar with the technique, LCBDE is a safe and feasible alternative for managing CBDS. The advantages are most pronounced in the case of multiple and large CBDS. The risk for retained stones and stricture is low.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Common Bile Duct Exploration: 9 Years Experience from a Single Center

2016

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“…With the high volume of surgical cases, the overall mortality due to gallstone disease and its treatment has remained stable, which is in part due to the high surgical volume with its associated low, but still important morbidity and mortality [90,100,101]. Thus, prophylactic cholecystectomy, previously suggested in high-risk population or as a strategy to prevent gallbladder cancer, has been largely abandoned due to an unfavorable risk-benefit ratio and missing impact on gallbladder cancer in epidemiologic studies [102][103][104][105][106].…”

Section: Treatmentmentioning

confidence: 98%

Black Bile of Melancholy or Gallstones of Biliary Colics: Historical Perspectives on Cholelithiasis

Bielefeldt

2014

Dig Dis Sci

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Barely 130 years after its first description, cholecystectomies are among the most commonly performed surgeries in the USA. The success of this operation with subsequent technical improvements, such as laparoscopic approaches, caused a paradigm shift in the management of gallstone disease. However, symptoms persist in 10-40 % of successfully operated patients. Reviewing monographs, textbooks, and articles published during the last 300 years, several important factors emerge as likely contributors to limited or poor treatment responses. Early on, clinicians recognized that cholelithiasis is quite common and thus often an incidental finding, especially if patients present with vague or atypical symptoms. Consistent with these observations, patients with such atypical symptoms are less likely to benefit from cholecystectomy. Similarly, lasting improvements are more reliably seen in patients with symptoms of presumed biliary origin and documented gallstones compared to individuals without stones, an important point in view of increasing rates of surgery for biliary dyskinesia. While cholelithiasis can cause serious complications, the overall incidence of clinically relevant problems is so low that prophylactic cholecystectomy cannot be justified. This conclusion corresponds to epidemiologic data showing that the rise in elective cholecystectomies decreased hospitalizations due to gallstone disease, but was associated with a higher volume of postoperative complications, ultimately resulting in stable combined mortality due to gallstone disease and its treatment. These trends highlight the tremendous gains in managing gallstone disease, while at the same time reminding us that the tightening rather than expanding indications for cholecystectomy may improve outcomes.

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“…Prophylactic cholecystectomy including cholangioscopy (endoscopic visualization of bile ducts) during gastric bypass surgery is promoted by some authors in order to minimize post‐operative difficulties , whereas others only support such an approach in patients with manifest symptomatic biliary disease before undergoing RYGB . Recent results from a Swiss cohort gave some evidence that cost effectiveness might be an additional argument to perform prophylactic cholecystectomy .On the other hand, a large Swedish population‐based cohort study in more than 13 000 patients over a 22‐year period reported a low risk of suffering from gallstones after bariatric surgery . To date, prophylactic cholecystectomy simultaneously performed along with bariatric surgery remains controversial.…”

Section: Altered Anatomy‐induced Difficultiesmentioning

confidence: 99%

Review article including treatment algorithm: endoscopic treatment of luminal complications after bariatric surgery

Valli

Gubler

2017

Clinical Obesity

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The worldwide number of performed bariatric surgeries is increasing continuously, whereas laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy are conducted most frequently. Alongside with the usual post-operative and metabolic complications, luminal complications such as anastomotic bleeding, ulceration, leakage, fistula formation, enlargement and stenosis of the anastomosis may occur. Evolution of interventional endoscopy frequently allows endoscopic management of complications, avoiding surgical interventions in most cases. Here, we review the various luminal complications after bariatric surgery with a focus on their endoscopic management.

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Population-based study of the need for cholecystectomy after obesity surgery

Cited by 39 publications

References 21 publications

Laparoscopic Common Bile Duct Exploration: 9 Years Experience from a Single Center

Laparoscopic Common Bile Duct Exploration: 9 Years Experience from a Single Center

Black Bile of Melancholy or Gallstones of Biliary Colics: Historical Perspectives on Cholelithiasis

Review article including treatment algorithm: endoscopic treatment of luminal complications after bariatric surgery

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