Gallstone-related complications after Roux-en-Y gastric bypass: a prospective study
Rachid G Nagem, Alcino Lázaro-da-Silva, Rafael Morroni de Oliveira and Valter Garcia Morato
Belo Horizonte, Brazil

BACKGROUND: Gastric bypass is a widespread bariatric
procedure that carries a high incidence of gallstone formation
postoperatively. Controversy exists regarding the importance
and consequences of gallstones in these patients. There are
surgeons who consider gallstone-related complications
after gastric bypass important enough to require routine
removal of the gallbladder during gastric bypass (prophylactic
cholecystectomy). However, this can lead to increased costs
and risks. This study aimed to identify complications related to
cholelithiasis after Roux-en-Y gastric bypass (RYGBP).
METHODS: This is a prospective observational study of 40
morbidly obese patients free of gallbladder disease. The patients
underwent open RYGBP at a public hospital in Brazil from
February to October 2007. They were followed up clinically and
ultrasonographically at 6 months and 1, 2, and 3 years after
surgery. Of the patients, 38 patients were followed up for 3 years.
RESULTS: Eleven patients (28.9%) developed cholelithiasis,
four (10.5%) experienced biliary pain, and 2 suffered from
acute biliary pancreatitis (5.3%). These patients had their
gallbladders removed laparoscopically. No patient presented
with acute cholecystitis, choledocholithiasis, or bile duct
dilation during the follow-up period. There were no deaths.
CONCLUSIONS: Gallstone-related complications after RYGBP
were relatively common. Some of these complications, like acute
pancreatitis, are known to have potentially severe outcomes. It
seems reasonable to perform cholecystectomy during gastric
bypass in the presence of cholelithiasis or after this procedure if
gallstones develop.
(Hepatobiliary Pancreat Dis Int 2012;11:630-635)