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Morbidity of cholecystectomy and gastric bypass in a national database.

Published: 18th October 2017

Authors: V. Wanjura, E. Szabo, J. Österberg, J. Ottosson, L. Enochsson, G. Sandblom et al.

Background

There is a strong association between obesity and gallstones. However, there is no clear evidence regarding the optimal order of Roux‐en‐Y gastric bypass (RYGB) and cholecystectomy when both procedures are clinically indicated.

Method

Based on cross‐matched data from the Swedish Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (GallRiks; 79 386 patients) and the Scandinavian Obesity Surgery Registry (SOReg; 36 098 patients) from 2007 to 2013, complication rates, reoperation rates and operation times related to the timing of RYGB and cholecystectomy were explored.

Results

There was a higher aggregate complication risk when cholecystectomy was performed after RYGB rather than before (odds ratio (OR) 1·35, 95 per cent c.i. 1·09 to 1·68; P = 0·006). A complication after the first procedure independently increased the complication risk of the following procedure (OR 2·02, 1·44 to 2·85; P < 0·001). Furthermore, there was an increased complication risk when cholecystectomy was performed at the same time as RYGB (OR 1·72, 1·14 to 2·60; P = 0·010). Simultaneous cholecystectomy added 61·7 (95 per cent c.i. 56·1 to 67·4) min (P < 0·001) to the duration of surgery.

Conclusion

Cholecystectomy should be performed before, not during or after, RYGB.

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