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Elective Cholecystectomy During Laparoscopic Roux-En-Y Gastric Bypass: Is it Worth the Wait?
Abstract
Background Combined gastric bypass and cholecystectomy have been advocated for open bariatric procedures. Our goal was to evaluate the safety of this technique in laparoscopic bariatric surgery patients with gallstones diagnosed preoperatively. Methods 94 out of 556 consecutive morbidly obese patients (16.9%) underwent laparoscopic gastric bypass with simultaneous cholecystectomy (LGBP/LC) for cholelithiasis. Results 328 patients (59%) had a concomitant secondary procedure, most commonly cholecystectomy (28.7%). Preoperative BMI was 48.6 +/- 6.9 kg/m2 for LGBP/LC patients and 48.8 +/- 7.3 kg/m2 (P = 0.85) for LGBP alone. 5 patients had preoperative biliary colic; the others were asymptomatic for cholelithiasis. Postoperatively, at a mean follow-up of 7.6 +/- 6.7 months, the percent excess weight loss (%EWL) was 46.1 +/- 0.25 for the combined procedure vs 50.2 +/- 63.0 (P = 0.55) for LGBP alone. There were no conversions to open procedures for the LC. Port placement for the LGBP was not altered for LC. None required intraoperative cholangiography. Operative time for the combined procedure was 293.4 +/- 79.8 minutes vs 244.8 +/- 77.2 minutes for LGBP alone (P Conclusion Concomitant LGBP/LC is safe and feasible without altering port placement. Combining these procedures significantly increases operative time and nearly doubles the hospital stay.
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Alterations of the ratio of cholesterol to bile salts within the gallbladder occur in weight fluctuations and rapid weight loss, reflecting increased hepatic cholesterol secretion and synthesis and reduced secretion of bile salts.
“Alterations of the ratio of choles-DOI: 10.1159/000516418 terol to bile salts within the gallbladder were observed in the setting of weight fluctuations and in rapid weight loss [37], reflecting increased hepatic cholesterol secretion and synthesis as well as a reduced secretion of bile salts [18].”
From Excess Body Weight and Gallstone Disease (2021) · cites this paper as [37]
Impairment in gallbladder motility occurs in weight fluctuations and rapid weight loss, triggering the formation of biliary sludge.
“An impairment in gallbladder motility also occurs, which triggers the formation of biliary sludge [37,38].”
From Excess Body Weight and Gallstone Disease (2021) · cites this paper as [37]
Randomized controlled trials in obese patients demonstrated that the risks of gallstones during weight loss diets are mitigated to a certain degree when the diets have a higher fat content.
“Randomized controlled trials in obese patients have demonstrated these risks to be mitigated to a certain degree when weight loss diets have a higher fat content [37,52,53].”
From Excess Body Weight and Gallstone Disease (2021) · cites this paper as [37]
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Stokes, C. S., Gluud, L. L., Casper, M., & Lammert, F. (2014) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2013.11.031 · Cited by 118
Excess Body Weight and Gallstone Disease
Stokes, C. S., & Lammert, F. (2021) · Visceral Medicine · doi:10.1159/000516418 · Cited by 58
Metadata
- Authors
- Hamad, G. G., Ikramuddin, S., Gourash, W. F., & Schauer, P. R.
- Venue
- Obesity Surgery
- Published
- 2003-02-01
- Volume
- 13
- Issue
- 1
- Pages
- 76-81
- ISSN
- 1708-0428
- 0960-8923
- Cited by
- 115
- References
- 0
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