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Concomitant Cholecystectomy During Laparoscopic Roux-en-Y Gastric Bypass in Obese Patients Is Not Justified: A Meta-Analysis

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Abstract

While LRYGB has become a cornerstone in the surgical treatment of morbidly obese patients, concomitant cholecystectomy during LRYGB remains a matter of debate. The aim of this meta-analysis was to estimate the rate and morbidity of subsequent cholecystectomy after laparoscopic Roux-en-Y gastric bypass (LRYGB) in obese patients. A meta-analysis was performed analyzing the rate and morbidity of subsequent cholecystectomy in patients who underwent LRYGB without concomitant cholecystectomy. Thirteen studies met the inclusion criteria. The rate of subsequent cholecystectomy was 6.8 % (95 % CI, 5.0–8.7 %) based on 6,048 obese patients who underwent LRYGB without concomitant cholecystectomy. The rate of subsequent cholecystectomy due to biliary colic or gallbladder dyskinesia was 5.3 %; due to cholecystitis, 1.0 %; choledocholithiasis, 0.2 %; and biliary pancreatitis, 0.2 %. The mortality after subsequent cholecystectomy was 0 % (95 % CI, 0–0.1 %). The surgery-related complication rate after subsequent cholecystectomy was 1.8 % (95 % CI, 0.7–3.4 %) resulting in a risk of 0.1 % (95 % CI, 0.03–0.3 %) to suffer from a cholecystectomy-related complication in patients undergoing LRYGB without concomitant cholecystectomy. A prophylactic concomitant cholecystectomy during LRYGB should be avoided in patients without cholelithiasis and exclusively be performed in patients with symptomatic biliary disease.

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Notes

  1. All proportions throughout the manuscript are results of random effect meta-analysis. Therefore, they may differ from plain numerical proportions.

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Conflicts of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Rene Warschkow, Ignazio Tarantino, Kristjan Ukegjini, Ulrich Beutner, Bruno M. Schmied, Sascha A. Müller, Bernd Schultes & Martin Thurnheer

  2. Institute of Medical Biometry and Informatics, University of Heidelberg, 69120, Heidelberg, Germany

    Rene Warschkow

  3. University Clinics for Visceral Surgery and Medicine, University Hospital Berne, 3010, Berne, Switzerland

    Ulrich Güller

  4. Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland

    Ulrich Güller

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  1. Rene Warschkow
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  2. Ignazio Tarantino
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  3. Kristjan Ukegjini
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  4. Ulrich Beutner
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Corresponding author

Correspondence to Ignazio Tarantino.

Additional information

R. Warschkow and I. Tarantino contributed equally to this study.

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Warschkow, R., Tarantino, I., Ukegjini, K. et al. Concomitant Cholecystectomy During Laparoscopic Roux-en-Y Gastric Bypass in Obese Patients Is Not Justified: A Meta-Analysis. OBES SURG 23, 397–407 (2013). https://doi.org/10.1007/s11695-012-0852-4

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