Alimentary Limb Research Articles

A Large Reaccumulating Cystic Lesion in a Gastric Bypass Patient

Purpose: A 42 yo AAF with HTn, bipolar disorder, chronic ethanol abuse, breast reduction 6y ago and gastric bypass 4y ago came with abdominal pain and an epigastric lump. A CT scan showed a large multiloculated cystic collection anterior to pancreas extending up to the pelvis. It was assessed as a pancreatic pseudocyst secondary to ethanolinduced pancreatitis. She was treated with bowel rest, TPN and octreotide. When no regression observed after 3 weeks a CT guided catheter drainage was performed. The drainage was persistently high around 1.5 litres/day with high levels of amylase and lipase in fluid analysis. The collection resolved after a few days but recurred after catheter dislodgment. The patient began complaining of abdominal discomfort. ERCP was technically infeasible because of previous gastric bypass surgery. She was transferred to a tertiary care facility where a repeat CT scan was interpreted as obstruction and distention of excluded stomach/duodenal limb from the previous gastric bypass surgery. Upon exploratory laparotomy the biliopancreatic limb was was found incarcerated and atretic through the Peterson's space. Resection and anastomosis was performed and a gastrostomy tube was placed. The postop period was uneventful. The gastrostomy tube was removed after 4 days. Her symptoms resolved completely, she was discharged on regular diet. No recurrences were reported till 6 mo in follow ups. Internal hernias have been reported in 0.2-9% of gastric bypass patients. (1) Petersen's type is one of the rarest type which occurs through the potential gap between the jejunal mesentery and mesocolon behind the alimentary limb. (2) With the growing number of bariatric surgeries nowadays, awareness of such a complication is pertinent to avoid misdiagnosis and delay in definitive surgical management as happened in this case. Bibliography: 1. Filip JE, et al. Internal hernia formation after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Am Surg 2002; 68:640-3. 2. Patel RY, et al. Internal hernia complications of gastric bypass surgery in the acute setting: spectrum of imaging findings. Emerg Radiol. DOI 10.1007/s10140-008-0781-7.Figure: Petersen's space.

Brown Bowel Syndrome Secondary to Jejunoileal Bypass: The First Case Report

A 58-year-old woman with a surgical history of jejunoileal bypass in 1980 for weight reduction sought medical attention with multiple complaints. The patient had not been taking any nutritional supplements since her bypass surgery, 26 years previously. She was found to have osteomalacia, chronic diarrhea, secondary hyperparathyroidism, and hyperoxaluria with a frequent history of nephrolithiasis. Because of her severe osteodystrophy and metabolic complications, reversal of her jejunoileal bypass was recommended. Reversal of the jejunoileal bypass with a sleeve gastrectomy was performed. Laparotomy revealed brown discoloration of the entire alimentary limb with atrophy of the bypassed intestinal limb. Histologic examination of the resected small bowel demonstrated brown pigment deposits within smooth muscle cells of the bowel wall. The pigment stained positive with Fontana-Masson most likely representing lipofuscin. We report a case of brown bowel syndrome complicating jejunoileal bypass, the first case reported in the literature to the best of our knowledge.

P-30: Intestinal obstruction after laparoscopic Roux-en-Y gastric bypass: Antecolic versus retrocolic Roux limb

Intestinal obstruction has become more common with utilization of the laparoscopic technique during gastric bypass for the treatment of morbid obesity. Controversy exists regarding the optimal course for the alimentary limb to reduce the incidence of intestinal obstruction during laparoscopic Roux-en-Y gastric bypass (LRYGB).

PL-310: Zero internal hernia rate using a retrocolic, retrogastric alimentary limb in 847 laparoscopic Roux-en-Y gastric bypass operations

Retrocolic, retrogastric placement of the alimentary limb during laparoscopic Roux-en-Y gastric bypass (LRYGB) has been implicated in a higher rate of internal hernia (IH). This study examines the incidence of IH in our series of LRYGB with retrocolic, retrogastric routing of the alimentary limb accompanied by routine secure closure of all mesenteric defects.

Obesity Surgery Results Depending on Technique Performed: Long-Term Outcome

Many techniques have excellent results at 2 years of follow-up but some matters regarding their long-term efficacy have arisen. This is why bariatric surgery results must be analyzed in long-term follow-up. The aim of this study was to extend the analysis over 5 years, evaluating weight loss, morbidity, and mortality of the surgical procedures performed. This was a retrospective cohort study of the different procedures for morbid obesity practiced in our Department of Surgery for morbid obesity. The results have been analyzed in terms of weight loss, morbidity improvement, and postoperative morbidity (Bariatric Analysis And Reporting Outcome System). One hundred twenty-five patients were operated on open vertical banded gastroplasty (VBG), 150 patients of open biliopancreatic diversion (BPD) of Scopinaro, 100 patients of open modified BPD (common limb 75 cm; alimentary limb 225 cm), and 115 patients of laparoscopic Roux-en-Y gastric bypass (LRYGBP). Mean follow-up was: VBG 12 years, BPD 7 years, and LRYGBP 4 years. An excellent initial weight loss was observed at the end of the second year of follow-up in all techniques, but from this time an important regain of weight was observed in VBG group and a discrete weight regain in LRYGBP group. Only BPD groups kept excellent weight results so far in time. Mortality was: VBG 1.6%, BPD 1.2%, and LRYGBP 0%. Early postoperative complications were: VBG 25%, BPD 20.4%, and LRYGBP 20%. Late postoperative morbidity was: protein malnutrition 11% in Scopinaro BPD, 3% in Modified BPD group, and no cases reported either in VBG group or LRYGBP group; iron deficiency 20% VBG, 62% Scopinaro BPD, 40% modified BPD, and 30.5% LRYGBP. A 14.5% of VBG group required revision surgery to gastric bypass or to BPD due to 100% weight regain or vomiting. A 3.2% of Scopinaro BPD with severe protein malnutrition required revision surgery to lengthen common limb to 100 cm. A 0.8% of LRYGBP required revision surgery to distal LRYGBP (common limb 75 cm) due to 100% weight regain. The most complex bariatric procedures increase the effectiveness but unfortunately they also increase morbidity and mortality. LRYGBP is safe and effective for the treatment of morbid obesity. Modified BPD (75-225 cm) can be considered for the treatment of superobesity (body mass index > 50 kg/m(2)), and restrictive procedures such as VBG should only be performed in well-selected patients due to high rates of failure in long-term follow-up.

Bile reflux after Roux-en- Y gastric bypass: an unrecognized cause of postoperative pain

Background To determine, in a private practice, whether symptomatic bile reflux can occur after Roux-en- Y gastric bypass (RYGB) for morbid obesity and the outcome after laparoscopic alimentary (Roux) limb lengthening. Bile reflux as a cause of pain after laparoscopic RYGB has not been previously described. We report on a series of patients with chronic pain after RYGB as a result of bile reflux owing an abnormally short alimentary limb. Methods A prospective database of patients who underwent revisional surgery to treat symptomatic bile reflux at our center was retrospectively reviewed and analyzed for the onset of symptoms, interval to revision, length of alimentary limb, and outcome after revision. Results A total of 16 patients were diagnosed with bile reflux and underwent revisional surgery. The onset of symptoms occurred at 58.3 ± 22.2 months after RYGB. All patients complained of pain, 13 (81.3%) had vomiting, and 7 (43.8%) had dysphagia. Endoscopy was performed in all patients and confirmed the presence of bile in all patients and detected marginal ulceration in 5 (31.3%) and gastritis in 8 (50.0%). At revisional surgery, the mean alimentary limb length was 37.7 ± 12.4 cm (range 20–62 cm). At a mean follow-up of 14.9 months after revision, all patients had reported resolution of their symptoms. Conclusion Although previously unreported after RYGB, bile reflux can be an important possible cause of chronic pain. Bile reflux, however, responds favorably to alimentary limb lengthening to 100 cm and was not been seen in patients with an alimentary limb length >62 cm.

Small Bowel Obstruction Due to Retrograde Intussusception After Laparoscopic Roux-en-Y Gastric Bypass

A 39-year-old female presented 4 years after laparoscopic Roux-en-Y gastric bypass with colicky abdominal pain, vomiting and inability to pass flatus. She had lost 100% of her excess weight after surgery and her body mass index had dropped from 46 to 22 kg/m(2). At exploration, a retrograde intussusception of the small bowel was noted distally to the jejunojejunostomy causing obstruction of the alimentary and biliopancreatic limb and gastric remnant. The intussusception was irreducible with signs of bowel ischaemia and required excision. The patient made an uneventful recovery. Colicky abdominal pain in a bariatric patient persisting more than 4 h mandates urgent investigation with abdominal computed tomography. Emergency care doctors should be aware of this specific complication in bariatric patients and seek expert advice.

Larrad Biliopancreatic Diversion in Sprague-Dawley Rats. Analysis of Weight Loss Related to Food Intake

Existing medical therapeutic strategies to achieve and maintain clinically significant weight loss in morbid obesity remain limited and the biliopancreatic diversion (BPD) is still the most effective among the bariatric surgical procedures. Our objective was to evaluate the weight and food intake after this procedure in a rat model. Rats randomly underwent one of the following protocols (1) BPD (n = 12) versus sham (n = 12) with a follow-up period of 30 days and (2) BPD (n = 4) versus pair-fed (PF; n = 4) with a follow-up period of 50 days. Under intraperitoneal anesthesia with ketamine-xilacine, a subcardinal corpo-antral gastrectomy was made, preserving the gastric fundus that was anastomosed to a jejunal limb after dissecting the proximal jejunum 5 cm below the ligament of Treitz to form the alimentary limb. The biliopancreatic limb was terminolaterally anastomosed to the distal ileum 5 cm above the ileocecal valve to form the common limb. Sham animals underwent only abdominal incision. Weight and food intake were measured every day. In protocol 1, after postoperative day 30, BPD rats exhibited a mean weight reduction of 17.9% while shams increased 12.4%. There was no difference in food intake adjusted per 100 g of body weight. In protocol 2, after postoperative day 50, BPD rats had a mean weight reduction of 22.6% and, despite increasing their caloric intake from a mean of 42.6 after 6 days to 65.8 kcal/day after 50 days, they kept a similar mean weight of 344.0 and 340.2 g, respectively; on the contrary, PF rats exhibited a 30.8% body weight gain. After the BPD, body weight is maintained independently of changes in food and energy intake.

Laparoscopic Gastric Bypass at a Large Academic Medical Center: Lessons Learned from the First 1000 Cases

Bariatric surgery is an effective and durable treatment for morbid obesity in properly selected patients. Surgical outcomes and patient management methods should routinely be reviewed to improve patient care and maintain long-term effectiveness of the bariatric operation. Over a 5-year period, 1096 laparoscopic Roux-en-Y gastric bypass operations were performed at our institution. A comprehensive prospective database was maintained, which included data for comorbidities, operative techniques, perioperative management, complications, and follow up. Many practice patterns such as the omission of routine preoperative sleep apnea testing and biliary ultrasounds remained constant and were validated by the outcomes measured. Several changes, however, were implemented based on outcomes analyses, including antecolic placement of the roux limb, a pars flaccida approach to the creation of the gastric pouch, longer alimentary limbs in superobese patients, and a selective approach to postoperative upper gastrointestinal imaging. Postoperative weight regain and inability to maintain long-term follow up in a significant per cent of patients were two identified and ongoing problems. Maintenance of a bariatric patient database is essential with its routine review resulting in changes to practice patterns and operative techniques. An effective method for long-term patient follow up remains elusive and may contribute to postoperative weight regain in some patients.

Factors Associated With Weight Loss After Gastric Bypass

Gastric bypass (GBP) is the most common operation performed in the United States for morbid obesity. However, weight loss is poor in 10% to 15% of patients. We sought to determine the independent factors associated with poor weight loss after GBP. Prospective cohort study. We examined demographic, operative, and follow-up data by means of multivariate analysis. Variables investigated were age, sex, race, marital and insurance status, initial weight and body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared), comorbidities (diabetes mellitus, hypertension, joint disease, sleep apnea, hyperlipidemia, and psychiatric disease), laparoscopic vs open surgery, gastric pouch area, gastrojejunostomy technique, and alimentary limb length. University tertiary referral center. All patients at our institution who underwent GBP from January 1, 2003, through July 30, 2006. Weight loss at 12 months defined as poor (< or =40% excess weight loss) or good (>40% excess weight loss). Follow-up data at 12 months were available for 310 of the 361 patients (85.9%) undergoing GBP during the study period. Mean preoperative BMI was 52 (range, 36-108). Mean BMI and excess weight loss at follow-up were 34 (range, 17-74) and 60% (range, 8%-117%), respectively. Thirty-eight patients (12.3%) had poor weight loss. Of the 4 variables associated with poor weight loss in the univariate analysis (greater initial weight, diabetes, open approach, and larger pouch size), only diabetes (odds ratio, 3.09; 95% confidence interval, 1.35-7.09 [P = .007]) and larger pouch size (odds ratio, 2.77;95% confidence interval, 1.81-4.22 [P <.001]) remained after the multivariate analysis. Gastric bypass results in substantial weight loss in most patients. Diabetes and larger pouch size are independently associated with poor weight loss after GBP.

Stent migration causing alimentary limb obstruction necessitating laparotomy and surgical stent extraction

Stent migration causing alimentary limb obstruction necessitating laparotomy and surgical stent extraction

Antiperistaltic (retrograde) intussusception after laparoscopic Roux-en- Y gastric bypass procedure

R F t Small bowel obstructions are a well-recognized compliation after Roux-en-Y gastric bypass. Rarely, small bowel ntussusception causes the obstruction [1–13]. The prevailng hypothesis is that postoperative alterations in small bowel otility lead to this unusual complication [1,3,4,7–9]. A 46-year-old woman had undergone laparoscopic, retocolic, retrogastric Roux-en-Y gastric bypass 5 years beore presentation. Her body mass index had decreased from 5 to 26 kg/m. She presented with 8 hours of periumbilical bdominal pain, nausea, and bilious emesis. The physical xamination revealed a distended, tympanitic abdomen with yperactive bowel sounds and mild diffuse tenderness to alpation. Radiographs demonstrated dilated small bowel nd an abnormal soft-tissue density in the mid-abdomen Fig. 1). Contrast-enhanced computed tomography showed small bowel obstruction distal to the jejunojejunal anasomosis with intussusception (Fig. 2). Laparotomy revealed a retrograde intussusception startng 30-cm beyond the jejunojejunal anastomosis (Fig. 3). he common alimentary limb was also herniated through a ransverse mesocolon defect, although no obstruction was resent at this level. The intussusceptum (comprised of ommon channel) was manually reduced. Given the unclear tiology of the obstruction, the intussusceptum was reected. The mesocolonic hernia was reduced, and the meocolic and small bowel mesenteric defects were closed. athologic examination demonstrated mucosal necrosis and dema but no discrete lead point.

Influence of Jejunoileal and Common Limb Length on Weight Loss Following Roux-en-Y Gastric Bypass

Capella surgery is one of the technical variations of Roux-en-Y gastric bypass. The method includes the preparation of an alimentary (Roux) limb with a standardized length (110 cm) in order to induce deficiencies in the absorption of macronutrients and thereby contribute to weight loss. The recognized variation in jejunoileal length in humans (approximately 4 to 9 m) is not considered, although this range correlates with the wide variation in the length of the common limb. In order to assess the influence of variations in jejunoileal and common limb lengths on weight loss, intra-operative measurements were made of these segments on 100 patients undergoing Capella surgery. Patients were followed for a period of 1 year. Statistical analysis included subdivisions of the population by gender and body mass index. Average jejunoileal length was 671.4 +/- 115.7 cm (434-990 cm). Average common limb length was 505.3 +/- 113.3 cm (268-829 cm). No correlation was detected between jejunoileal length and weight loss at 6 months or 1 year following surgery. A weak negative correlation was detected between weight loss and common limb length at 1 year following surgery in male and super-obese patients. Jejunoileal and common limb length vary widely in gastric bypass patients. To make modifications in the alimentary and/or biliopancreatic limb length, surgeons must consider the variability of the jejunoileal and common limb length.

Comments on: Maintenance of weight loss in patients with body mass index &gt;60 kg/m2: importance of length of small bowel bypassed

Although the duodenal switch (DS) procedure has been preformed since Dr. Hess started doing this operation in 1989, the total number of procedures performed has been relatively small compared with the number of gastric bypass procedures. As a result, there is still a great deal we do not understand about the DS. Now, with the recent approval by the Centers for Medicare and Medicaid Services, it is very possible that the number of DS operations will increase. We do know that some degree of restriction results from the vertical gastrectomy and some degree of malabsorption occurs related to the bypass of a large amount of small intestine. We also know that the small bowel length varies significantly from patient to patient. Dr. Hess and others have recommended making bowel lengths of 10% for the common channel, with an additional 30% for the alimentary channel and 60% for the biliary channel. Dr. Rabkin recommended making the common channel 100 cm long, the alimentary channel an additional 150 cm long, and the biliary channel, the remainder of the small bowel length (commonly 300–500 cm). Both measured the small bowel lengths on stretch, and both created a more aggressive malabsorptive operation than in the present study in which the common channel was either 75 cm or 100 cm and the alimentary limb was either 250 cm or 300 cm of unstretched bowel.

PL-54: Bile reflux following Roux-en-Y gastric bypass: An unrecognized cause of post-operative pain

Bile reflux as a cause of pain following laparoscopic Roux-en-Y gastric bypass (LRYGB) has not been previously described. We report a series of patients with chronic pain following LRYGB as a result of bile reflux from an abnormally short alimentary limb.

Laparoscopic sleeve gastrectomy with ileal transposition (SGIT): A new surgical procedure as effective as gastric bypass for weight control in a porcine model

Bariatric surgery has evolved into multiple forms in the last decades, combining food restriction and malabsorption. The aim of this study was to develop a new technique based on food restriction and early stimulation of the distal gut, thus maintaining the alimentary tract continuity. Thirty-two Yorkshire pigs, weight 22.2 +/- 5.4 kg (mean +/- SD) were randomly assigned to four laparoscopic procedures: ileal transposition (IT, n = 8); sleeve gastrectomy with ileal transposition (SGIT, n = 8); Roux-en-Y gastric bypass (GBP, n = 8); sham operation (SHAM, n = 8). Firing 45-mm linear staplers over a 60-F bougie, resecting the greater curvature and fundus, constituted a sleeve gastrectomy. Ileal transposition was performed by isolating a 100-cm ileal segment proximal to the ileocecal valve and by dividing the proximal jejunum 15 cm distal to the ligament of Treitz and performing re-anastomosis. Gastric bypass consisted of creating a proximal gastric pouch and a 300 cm alimentary limb. Sham operation was performed by bowel transections and re-anastomosis in the ileum and proximal jejunum together with gastrotomy and closure. Animals were evaluated weekly for weight increase and food intake. We performed a logistic regression analysis to compare weight progression curves, and analysis of variance (ANOVA) and Bonferroni (Dunn) tests to detect differences in weight and food intake. We observed significant differences in mean weight after 18 weeks between SGIT (30.9 +/- 13.4 kg) and SHAM (72.5 +/- 10.7 kg) (p = 0.0002), and GBP (28.6 +/- 2.5 kg) and SHAM (p = 0.0001), and IT (56.1 +/- 13.4 kg) and SHAM (p = 0.0081). No differences were observed between RYGB and SGIT. We also observed significant differences in food intake (grams per day) in the third month between SGIT (1668 +/- 677 g) versus SHAM (3252 +/- 476 g) (p = 0.0006), and GBP (2011 +/- 565 g) versus SHAM (p = 0.039). No differences were observed in food intake between SGIT and GBP. SGIT proved to be as effective in the short term as GBP on weight progression with no bypass of the proximal gut.

Maintenance of weight loss in patients with body mass index &gt;60 kg/m2: importance of length of small bowel bypassed

It is commonly believed that weight loss after biliopancreatic diversion/duodenal switch is inversely related to the length of the alimentary limb and the common channel. However, the effect of the biliopancreatic limb length (BPL) on weight loss has received little attention. A total of 1001 patients after biliopancreatic diversion/duodenal switch (209 men and 792 women, mean age 42 +/- 10 yr, mean body mass index [BMI] 52 +/- 9 kg/m(2)) were divided into 2 groups according to the ratio of the BPL to the total small bowel length (SBL): a BPL < or =45% of the SBL versus a BPL >45% of the SBL. The nutritional parameters and percentage of excess weight loss were compared between the 2 groups. In patients with a BMI of < or =60 kg/m(2), the percentage of excess weight loss at 1 year postoperatively was 66.8% for those with a BPL < or =45% of the SBL and 69.3% for those with a BPL >45% of the SBL (P = NS). At 2 years, the corresponding percentages were 73.7% and 79.5% (P = NS) and, at 3 years, were 73.4% and 75.2% (P = NS). In patients with a BMI >60 kg/m(2), the corresponding percentages of excess weight loss was 56.8% versus 61.4% (P = .07) at 1 year, 62.2% versus 77.5% (P = .04) at 2 years, and 59.8% versus 77.5% at 3 years (P = .05). The results of our study have shown that amount of weight lost after biliopancreatic diversion/duodenal switch is directly related to the proportion of small bowel bypassed in patients with a BMI >60 kg/m(2). Also, the effect increased with the duration of follow-up. In less heavy patients, the BPL/SBL ratio had a minimal effect on long-term weight loss and a more pronounced effect on nutritional parameters.

Laparoscopic hiatal hernia repair and repeat sleeve gastrectomy for gastroesophageal reflux disease after duodenal switch

Hiatal hernia is frequently seen in the bariatric population. It is often associated with severe reflux that can lead to a decreased quality of life and poor weight loss or even weight regain after bariatric surgery. We present a patient who complained of severe reflux and weight regain 5 years after laparoscopic biliopancreatic diversion with a duodenal switch (BPD-DS). The associated video demonstrates the laparoscopic repair of the patient’s hiatal hernia (including reduction of the incarcerated sleeve and crural repair) and “re-sleeve” gastrectomy. Case report The patient was a 49-year-old woman who had undergone laparoscopic BPD-DS 5 years before for a body mass index (BMI) of 55 kg/m 2 . At that time, the sleeve gastrectomy was performed over a 60F Bougie, and the duodenal switch consisted of a 150-cm alimentary limb and 100-cm common channel. She had no medical problems, and her surgical history was relevant for open cholecystectomy before her BPD-DS. Her lowest BMI postoperatively was 28 kg/m 2 . She had recently complained of epigastric pain, severe reflux, and weight regain (BMI 31 kg/m 2 ). An upper

Postoperative Morbidity of Biliopancreatic Diversion Depending on Common Limb Length

Laparoscopic gastric bypass, currently the most popular surgical method for bariatric therapy, have proved to be effective in weight loss, but some matters regarding its long-term efficacy for super-obese patients (BMI >50 kg/m2) have arisen. Biliopancreatic diversion (BPD) is a complex technique that has shown good results in the treatment of the super-obese patient. We analyze our >5 years results, evaluating weight loss, morbidity and mortality of this operation, depending on the length of the common and alimentary limbs. We studied two series of patients: 150 patients with BPD of Scopinaro (50-200 cm) and 70 patients with modified BPD (75-225 cm). The results have been analyzed in terms of weight loss, co-morbidity improvement, and postoperative morbidity using BAROS. Range of follow-up is 1-12 years. Weight loss was slightly higher for the Scopinaro group than for the Modified group but with no significant difference. There was more prevalence of malnutrition and of iron deficiency in the Scopinaro group (16% and 60%) than in the modified group (2% and 40%), with similar postoperative morbidities. The modified BPD method (75-225 cm) shows long-term effectiveness in weight loss and comorbidity improvement for super-obesity. Proteins, vitamins and oligoelement deficits appear distant in time, and thus it is necessary to maintain strict followup of these patients and supplement against deficiencies for the rest of their lives.

Routine cholecystectomy during laparoscopic biliopancreatic diversion with duodenal switch is not necessary

Similar to gastric bypass patients, a regimen of ursodeoxycholic acid in the immediate postoperative period might obviate the need for routine cholecystectomy. Routine cholecystectomy has been recommended for patients who undergo biliopancreatic diversion (BPD), because of the high prevalence of gallstones in the obese patient and presumed development of gallstones postoperatively. We have considered elective cholecystectomy only if gallbladder disease were present. The aim of this study was to assess the need for cholecystectomy in the postoperative period in such patients. In this retrospective study, the data from 219 patients who had undergone BPD with duodenal switch (BPD/DS), from January 1999 to January 2003, were analyzed. We performed a 150-cm alimentary limb and 100-cm common channel BPD/DS. The patients received 600 mg ursodeoxycholic acid orally daily for 6 months. The following data were recorded: demographics, medical history, medication, weight loss, diagnostic evaluation, and operative and pathologic data. Of the 219 patients who underwent surgery, 59 were men (26.9%) and 160 women were (73.1%) (mean age 41.7 years, mean body mass index 55.7 kg/m(2)). The mean follow-up was 30 months (range 12-48). Of the 219 patients, 57 (19.6%) underwent cholecystectomy: 28 (12.7%) preoperatively, 10 (4.5%) simultaneously, and 19 (8.7%) postoperatively. Simultaneous cholecystectomy was performed when the patient had a history of colic episodes with gallbladder disease (disclosed by preoperative ultrasonography). The postoperative cholecystectomy pathology reports showed cholecystitis in only 7 patients. The results of our study have shown that the incidence of postoperative cholecystectomy in BPD/DS patients is low, and cholecystitis is rare. Routine cholecystectomy in BPD/DS patients is no longer recommended.