Is Gallbladder Ultrasound Necessary in Patients Undergoing Laparoscopic Roux-en-Y Gastric Bypass?

Abstract

Purpose: We reviewed our patients with biliary disease undergoing laparoscopic Roux-en-Y gastric bypass (LRYGBP). Methods: From 7/1999–10/2004, 647 patients underwent LRYGBP in our institution and preoperative ultrasound (US) was available in 557. Preoperative US were routinely obtained early in our series and selectively thereafter, in patients with symptoms suspicious for biliary disease. Cholecystectomy at the time of LRYGBP was performed in symptomatic patients with positive US. Results: 137of 557 patients had cholecystectomy prior to LRYGBP. Ninety-seven of the remaining 424 patients had preoperative US. Thirty-five US+; 20/35 patients were symptomatic and underwent cholecystectomy at the time of LRYGBP. 15/35 with US+ did not undergo cholecystectomy since they were asymptomatic; 1/15 required laparoscopic cholecystectomy (LC). 62 had a negative preoperative ultrasound; 3/62 required LC at 1, 3 and 26 months postoperatively. Patients without preoperative US were followed-up for a mean of 10.5 months; 21/327 eventually required biliary surgery at a mean of 6.2 months postoperatively. 3/21 presented with common bile duct pathology that was treated with laparoscopic transgastric ERCP and sphincterotomy or open common bile duct exploration. Conclusions: Omission of preoperative US is associated with an acceptable rate of postoperative biliary disease, which can be treated laparoscopically safely.