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Marciniak C, Lenne X, Bruandet A, Hamroun A, Génin M, Baud G, Theis D, Pattou F, Caiazzo R. Risk-Benefit Balance of Simultaneous Gastric Bypass or Sleeve Gastrectomy and Concomitant Cholecystectomy: A Comprehensive Nationwide Cohort of 289,627 Patients. Ann Surg 2023; 278:725-731. [PMID: 37476980 DOI: 10.1097/sla.0000000000006039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To assess the relevance of concomitant laparoscopic metabolic bariatric surgery (MBS) and cholecystectomy. BACKGROUND Because of the massive weight loss it induces, MBS is associated with an increase in the frequency of gallstones. However, no consensus yet exists on the risk-to-benefit ratio of a concomitant cholecystectomy (CC) during MBS to prevent long-term biliary complications. METHODS This nationwide retrospective cohort research was conducted in 2 parts using information from a national administrative database (PMSI). The 90-day morbidity of MBS with or without CC was first compared in a matched trial (propensity score). Second, we observed medium-term biliary complication following MBS when no CC had been performed during MBS up to 9 years after MBS (minimum 18 months). RESULTS Between 2013 and 2020, 289,627 patients had a sleeve gastrectomy (SG: 70%) or a gastric bypass (GBP: 30%). The principal indications of CC were symptomatic cholelithiasis (79.5%) or acute cholecystitis (3.6%). Prophylactic CC occurred only in 15.5% of the cases. In our matched-group analysis, we included 9323 patients in each arm. The complication rate at day 90 after surgery was greater in the CC arm [odds ratio=1.3 (1.2-1.5), P <0.001], independently of the reason of the CC. At 18 months, there was a 0.1% risk of symptomatic gallstone migration and a 0.08% risk of biliary pancreatitis. At 9 years, 20.5±0.52% of patients underwent an interval cholecystectomy. The likelihood of interval cholecystectomy decreased from 5.4% per year to 1.7% per year after the first 18 months the whole cohort, risk at 18 months of symptomatic gallstone migration was 0.1%, of pancreatitis 0.08%, and of angiocholitis 0.1%. CONCLUSION CC during SG and GBP should be avoided. In the case of asymptomatic gallstones after MBS, prophylactic cholecystectomy should not be recommended.
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Affiliation(s)
- Camille Marciniak
- General and Endocrine Surgery Department, Lille University Hospital CHU Lille, Lille, France
- Inserm, U1190 Translational research on diabetes (EGID), Lille University Univ.Lille, Lille, France
| | - Xavier Lenne
- Medical Information Department, Lille University Hospital, Lille, France
| | - Amélie Bruandet
- Medical Information Department, Lille University Hospital, Lille, France
| | - Aghiles Hamroun
- Public health, Epidemiology - UMR 1167 Ridage, Institut Pasteur de Lille, Univ Lille, Chu Lille, Lille, France
| | - Michaël Génin
- University of Lille, CHU Lille, ULR 2694 - METRICS: Health technology and medical practice assessment, F-59000 Lille, France
| | - Grégory Baud
- General and Endocrine Surgery Department, Lille University Hospital CHU Lille, Lille, France
- Inserm, U1190 Translational research on diabetes (EGID), Lille University Univ.Lille, Lille, France
| | - Didier Theis
- Medical Information Department, Lille University Hospital, Lille, France
| | - François Pattou
- General and Endocrine Surgery Department, Lille University Hospital CHU Lille, Lille, France
- Inserm, U1190 Translational research on diabetes (EGID), Lille University Univ.Lille, Lille, France
| | - Robert Caiazzo
- General and Endocrine Surgery Department, Lille University Hospital CHU Lille, Lille, France
- Inserm, U1190 Translational research on diabetes (EGID), Lille University Univ.Lille, Lille, France
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Guan B, Chen Y, Wu Z, Chong TH, Ming WK, Wang C, Huang S, Lee WJ, Yang J. Combined Laparoscopic Bariatric Surgery and Thyroidectomy: A Proof-of-Concept Study. Bariatr Surg Pract Patient Care 2023. [DOI: 10.1089/bari.2022.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Affiliation(s)
- Bingsheng Guan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yanya Chen
- Department of Basic Nursing, School of Nursing, Jinan University, Guangzhou, China
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, China
| | - Zhenpeng Wu
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tsz Hong Chong
- Department of Thyroid Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wai-kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, China
| | - Cunchuan Wang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shifang Huang
- Department of Intensive Care Unit, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan, China
| | - Jingge Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
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Amorim-Cruz F, Santos-Sousa H, Ribeiro M, Nogueiro J, Pereira A, Resende F, Costa-Pinho A, Preto J, Lima-da-Costa E, Sousa-Pinto B. Risk and Prophylactic Management of Gallstone Disease in Bariatric Surgery: a Systematic Review and A Bayesian meta-analysis. J Gastrointest Surg 2023; 27:433-448. [PMID: 36627465 PMCID: PMC9974690 DOI: 10.1007/s11605-022-05567-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/18/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The frequency and management of gallstone disease (GD) in bariatric patients, including the role of routine prophylactic concomitant cholecystectomy (CCY), are still a matter of debate. This study aims to assess the risk of de novo GD in patients undergoing bariatric surgery (BS) and their predictive factors, as well as mortality and morbidity in prophylactic CCY compared to BS alone. METHODS We performed a systematic review, searching PubMed, EMBASE, and Web of Science until April 2021. We performed a Bayesian meta-analysis to estimate the risk of GD development after BS and the morbidity and mortality associated with BS alone versus BS + prophylactic CCY. Sources of heterogeneity were explored by meta-regression analysis. RESULTS The risk of de novo post bariatric GD was 20.7% (95% credible interval [95% CrI] = 13.0-29.7%; I2 = 75.4%), and that of symptomatic GD was 8.2% ([95% CrI] = 5.9-11.1%; I2 = 66.9%). Pre-operative average BMI (OR = 1.04; 95% CrI = 0.92-1.17) and female patients' proportion (OR = 1.00; 95% CrI = 0.98-1.04) were not associated with increased risk of symptomatic GD. BS + prophylactic CCY was associated with a 97% probability of a higher number of postoperative major complications compared to BS alone (OR = 1.74, 95% CrI = 0.97-3.55; I2 = 56.5%). Mortality was not substantially different between the two approaches (OR = 0.79; 95% CrI = 0.03-3.02; I2 = 20.7%). CONCLUSION The risk of de novo symptomatic GD after BS is not substantially high. Although mortality is similar between groups, odds of major postoperative complications were higher in patients submitted to BS + prophylactic CCY. It is still arguable if prophylactic CCY is a fitting approach for patients with a preoperative lithiasic gallbladder.
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Affiliation(s)
- Filipe Amorim-Cruz
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Hugo Santos-Sousa
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal. .,Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Miguel Ribeiro
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Jorge Nogueiro
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - André Pereira
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Surgery Department, São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Fernando Resende
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - André Costa-Pinho
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.,Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - John Preto
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Eduardo Lima-da-Costa
- Obesity Integrated Responsibility Unit (CRI-O), São João University Medical Center, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal.,CINTESIS - Center for Health Technologies and Services Research, University of Porto, Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
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Clinical Characteristics of Symptomatic Cholecystitis in Post-Gastrectomy Patients: 11 Years of Experience in a Single Center. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101451. [PMID: 36295611 PMCID: PMC9609371 DOI: 10.3390/medicina58101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/01/2022] [Accepted: 10/13/2022] [Indexed: 12/07/2022]
Abstract
Background and Objectives: Gallbladder (GB) stones, a major cause of symptomatic cholecystitis, are more likely to develop in post gastrectomy people. Our purpose is to evaluate characteristics of symptomatic cholecystitis after gastrectomy. Materials and Method: In January 2011−December 2021, total 1587 patients underwent operations for symptomatic cholecystitis at our hospital. We reviewed the patients’ general characteristics, operation results, pathologic results, and postoperative complications. We classified the patients into non-gastrectomy and gastrectomy groups, further divided into subtotal gastrectomy and total gastrectomy groups. Result: The patients’ ages, male proportion, and the open surgery rate were significantly higher (127/1543 (8.2%) vs. 17/44 (38.6%); p < 0.001), and the operation time was longer (102.51 ± 52.43 vs. 167.39 ± 82.95; p < 0.001) in the gastrectomy group. Extended surgery rates were significantly higher in the gastrectomy group (56/1543 (3.6%) vs. 12/44 (27.3%); p < 0.001). The period from gastrectomy to symptomatic cholecystitis was significantly shorter in the total gastrectomy group (12.72 ± 10.50 vs. 7.25 ± 4.80; p = 0.040). Conclusion: GB stones were more likely to develop in post-gastrectomy patients and extended surgery rates were higher. The period to cholecystitis was shorter in total gastrectomy. Efforts to prevent GB stones are considered in post-gastrectomy patients.
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Alqahtani A, Almayouf M, Billa S, Helmi H. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac130. [PMID: 35531438 PMCID: PMC9071462 DOI: 10.1093/jscr/rjac130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/15/2022] [Indexed: 11/12/2022] Open
Abstract
Concomitant surgery is an attractive option because of convenience. To our knowledge, this is the first study reporting concomitant laparoscopic sleeve gastrectomy (LSG) and laparoscopic right adrenalectomy. A retrospective review of three patients with obesity and a unilateral adrenal mass was conducted. The demographics, workup, surgical technique and outcome were presented. Patient 1 had a body mass index (BMI) of 41 kg/m2, diabetes mellitus (DM), hypertension (HTN) and a right adrenal pheochromocytoma. Patient 2 had a BMI of 40 kg/m2, insulin-dependent DM, uncontrolled HTN, chronic kidney disease, ischemic heart disease and an aldosterone secreting right adrenal adenoma. Patient 3 had a BMI of 41 kg/m2, dyslipidemia, HTN and gout. All patients underwent concomitant LSG and laparoscopic adrenalectomy (LA). LSG and LA is a feasible and safe concomitant surgery when performed under specific measures with minimal morbidity and more convenience.
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Affiliation(s)
- Awadh Alqahtani
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Almayouf
- Correspondence address. Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, P.O. Box: 173, Al-Kharj 11942, Saudi Arabia. Tel: +966-011-588-8888; E-mail:
| | - Srikar Billa
- Department of Surgery, Dr. Sulaiman Al-Habib Hospitals, Riyadh, Saudi Arabia
| | - Hadeel Helmi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Xia C, Wang M, Lv H, Li M, Jiang C, Liu Z, Yang Q. The Safety and Necessity of Concomitant Cholecystectomy During Bariatric Surgery in Patients with Obesity: a Systematic Review and Meta-analysis. Obes Surg 2021; 31:5418-5426. [PMID: 34564789 DOI: 10.1007/s11695-021-05713-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 02/08/2023]
Abstract
Concomitant cholecystectomy (CCE) during bariatric surgery(BS)in patients with obesity remains a matter of debate. This study aimed to estimate the safety and necessity of CCE during BS. This study analyzed the postoperative complications in patients who underwent CCE during BS and subsequent cholecystectomy rate following BS. Patients in CCE and BS-only groups had no difference in mortality. A higher postoperative complication rate was observed in the CCE group (OR 1.2, 95% CI 1.1-1.3) (p < 0.001) but no severe complication in both groups. Following BS, gallstone patients had a higher subsequent cholecystectomy rate than those with normal gallbladders (OR 2.47%, 95% CI 1.5-4.1) (p < 0.001). Concomitant cholecystectomy increased the rates of postoperative complications during BS. We only recommend CCE for documented gallstones rather than for normal gallbladder.
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Affiliation(s)
- Congying Xia
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Wang
- Section for HepatoPancreatoBiliary Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, No. 19 Yangshi Street, Chengdu, 610031, Sichuan, China
| | - Hailong Lv
- Section for HepatoPancreatoBiliary Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, No. 19 Yangshi Street, Chengdu, 610031, Sichuan, China
| | - Ming Li
- Section for HepatoPancreatoBiliary Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, No. 19 Yangshi Street, Chengdu, 610031, Sichuan, China
| | - Cuinan Jiang
- Section for HepatoPancreatoBiliary Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, No. 19 Yangshi Street, Chengdu, 610031, Sichuan, China
| | - Zehan Liu
- Section for HepatoPancreatoBiliary Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, No. 19 Yangshi Street, Chengdu, 610031, Sichuan, China
| | - Qin Yang
- Section for HepatoPancreatoBiliary Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & The Second Affiliated Hospital of Chengdu, Chongqing Medical University, No. 19 Yangshi Street, Chengdu, 610031, Sichuan, China.
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Controversies in the Preoperative Workup and Management for Patients Undergoing Bariatric Surgery: A Review of the Literature. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lee SH, Jang DK, Yoo MW, Hwang SH, Ryu SY, Kwon OK, Hur H, Man Yoon H, Eom BW, Ahn HS, Son T, Song KY, Lee HH, Choi MG, An JY, Lee SI, Lee KH, Ahn S, Park YS, Park DJ. Efficacy and Safety of Ursodeoxycholic Acid for the Prevention of Gallstone Formation After Gastrectomy in Patients With Gastric Cancer: The PEGASUS-D Randomized Clinical Trial. JAMA Surg 2021; 155:703-711. [PMID: 32584935 PMCID: PMC7301302 DOI: 10.1001/jamasurg.2020.1501] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance The incidence of gallstones has been reported to increase after gastrectomy. However, few studies have been conducted on the prevention of gallstone formation in patients who have undergone gastrectomy. Objective To evaluate the efficacy and safety of ursodeoxycholic acid (UDCA) in preventing gallstone formation after gastrectomy in patients with gastric cancer. Design, Setting, and Participants The PEGASUS-D study (Efficacy and Safety of DWJ1319 in the Prevention of Gallstone Formation after Gastrectomy in Patient with Gastric Cancer: A Multicenter, Randomized, Double-blind, Placebo-controlled Study) was a randomized, double-blind, placebo-controlled clinical trial conducted at 12 institutions in the Republic of Korea. Adults (aged ≥19 years) with a diagnosis of gastric cancer who underwent total, distal, or proximal gastrectomy were enrolled between May 26, 2015, and January 9, 2017; follow-up ended January 8, 2018. Efficacy was evaluated by both the full analysis set, based on the intention-to-treat principle, and the per-protocol set; full analysis set findings were interpreted as the main results. Interventions Eligible participants were randomly assigned to receive 300 mg of UDCA, 600 mg of UDCA, or placebo at a ratio of 1:1:1. Ursodeoxycholic acid and placebo were administered daily for 52 weeks. Main Outcomes and Measures Gallstone formation was assessed with abdominal ultrasonography every 3 months for 12 months. Randomization and allocation to trial groups were carried out by an interactive web-response system. The primary end point was the proportion of patients developing gallstones within 12 months after gastrectomy. Results A total of 521 patients (175 received 300 mg of UDCA, 178 received 600 mg of UDCA, and 168 received placebo) were randomized. The full analysis set included 465 patients (311 men; median age, 56.0 years [interquartile range, 48.0-64.0 years]), with 151 patients in the 300-mg group, 164 patients in the 600-mg group, and 150 patients in the placebo group. The proportion of patients developing gallstones within 12 months after gastrectomy was 8 of 151 (5.3%) in the 300-mg group, 7 of 164 (4.3%) in the 600-mg group, and 25 of 150 (16.7%) in the placebo group. Compared with the placebo group, odds ratios for gallstone formation were 0.27 (95% CI, 0.12-0.62; P = .002) in the 300-mg group and 0.20 (95% CI, 0.08-0.50; P < .001) in the 600-mg group. No significant adverse drug reactions were detected among the enrolled patients. Conclusions and Relevance Administration of UDCA for 12 months significantly reduced the incidence of gallstones after gastrectomy for gastric cancer. These findings suggest that UDCA administration prevents gallstone formation after gastrectomy in patients with gastric cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02490111.
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Affiliation(s)
- Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Kee Jang
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Moon-Won Yoo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun-Hwi Hwang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Seong-Yeob Ryu
- Department of Surgery, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Oh Kyoung Kwon
- Department of Surgery, Kyoungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Hoon Hur
- Department of Surgery, Ajou University Hospital, Suwon, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Hye Seong Ahn
- Department of Surgery, Boramae Medical Center, Seoul, Republic of Korea
| | - Taeil Son
- Department of Surgery, Yonsei University Severance Hospital, Seoul, Republic of Korea
| | - Kyo Young Song
- Department of Surgery, Catholic University of Seoul St Mary's Hospital, Seoul, Republic of Korea
| | - Han Hong Lee
- Department of Surgery, Catholic University of Seoul St Mary's Hospital, Seoul, Republic of Korea
| | - Min-Gew Choi
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Il Lee
- Department of Surgery, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kyung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Soyeon Ahn
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.,Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Port-sharing techniques for laparoscopic cholecystectomy and sleeve gastrectomy. Surg Today 2021; 51:1996-1999. [PMID: 34009434 DOI: 10.1007/s00595-021-02304-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
In Japan, the number of bariatric surgeries performed has remained low. Thus, concomitant laparoscopic cholecystectomy (LC) with laparoscopic sleeve gastrectomy (LSG) is still relatively uncommon, but is increasing. We developed new port-sharing techniques for LC and LSG, which we performed on 26 obese Japanese patients with gall bladder (GB) diseases, using the LSG trocar arrangement and one additional trocar. We performed LC first, and after exchanging a port for a liver retractor in the epigastrium, we then completed LSG. One patient with an anomalous extrahepatic bile duct required one additional port. The mean LC time was 55 min, and the transition to LSG just after LC was smooth in all the patients. One patient suffered postoperative intraperitoneal hemorrhage, which was managed conservatively. Concomitant LC with LSG using port-sharing techniques is feasible and safe for obese Japanese patients with GB diseases.
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Elgohary H, El Azawy M, Elbanna M, Elhossainy H, Omar W. Concomitant versus Delayed Cholecystectomy in Bariatric Surgery. J Obes 2021; 2021:9957834. [PMID: 34234964 PMCID: PMC8216831 DOI: 10.1155/2021/9957834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/01/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Obesity and weight loss after bariatric surgery have a close association with gallbladder disease. The performance and proper timing of laparoscopic cholecystectomy (LC) with bariatric surgery remain a clinical question. OBJECTIVE Evaluation of the outcome of LC during bariatric surgery whether done concomitantly or delayed according to the level of intraoperative difficulty. METHODS The prospective study included patients with morbid obesity between December 2018 and December 2019 with preoperatively detected gallbladder stones. According to the level of difficulty, patients were allocated into 2 groups: group 1 included patients who underwent concomitant LC during bariatric surgery, and group 2 included patients who underwent delayed LC after 2 months. In group 1, patients were further divided into subgroups: LC either at the beginning (subgroup A) or after bariatric surgery (subgroup B). RESULTS Operative time in group 1 vs. 2 was 92.63 ± 28.25 vs. 68.33 ± 17.49 (p < 0.001), and in subgroup A vs. B, it was 84.19 ± 19.62 vs. 130.0 ± 31.62 (p < 0.001). One patient in each group (2.6% and 8.3%) had obstructive jaundice, p > 0.001. In group 2, 33% of asymptomatic patients became symptomatic for biliary colic p > 0.001. LC difficulty score was 2.11 ± 0.70 vs. 5.66 ± 0.98 in groups 1 and 2, respectively, p < 0.001. LC difficulty score decreased in group 2 from 5.66 ± 0.98 to 2.26 ± 0.78 after 2 months of bariatric surgery, p < 0.001. CONCLUSION Timing for LC during bariatric surgery is challenging and should be optimized for each patient as scheduling difficult LC to be performed after 2 months may be an option.
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Affiliation(s)
- Hatem Elgohary
- General Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Mahmoud El Azawy
- General Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Mohey Elbanna
- Department of General Surgery, Faculty of Medicine, Ain-shams University, Cairo, Egypt
| | - Hossam Elhossainy
- General Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt
| | - Wael Omar
- General Surgery Department, Faculty of Medicine, Helwan University, Helwan, Egypt
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Abstract
Based on the available publications, the article presents an analysis of the studies on the simultaneous implementation of cholecystectomy, ventral and paraesophageal hernia repair during a bariatric intervention. If there is a clinical picture of chronic calculous cholecystitis, simultaneous cholecystectomy is justified and does not lead to a significant increase in the number of complications. In the case of asymptomatic gallstones, the optimal tactics remains controversial, both a surgical treatment and observation are possible. In the absence of gallstone disease, all patients after the surgical correction of the excess weight are prescribed ursodeoxycholic acid, while performing preventive cholecystectomy is not recommended. A simultaneous ventral hernia repair is justified only for small defects ( 10 cm) of the anterior abdominal wall. If a paraesophageal hernia is detected in patients with morbid obesity, bariatric surgery may be combined with cruroraphy.
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Asymptomatic Cholelithiasis and Bariatric Surgery: a Comprehensive Long-Term Analysis of the Risks of Biliary Disease in Patients Undergoing Primary Roux-en-Y Gastric Bypass. Obes Surg 2020; 31:1249-1255. [PMID: 33230759 DOI: 10.1007/s11695-020-05125-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Currently, there is little consensus on management of the in situ gallbladder of patients undergoing gastric bypass. Our aim was to evaluate outcomes of selective concomitant cholecystectomy (CCY) and long-term biliary outcomes after Roux-en-Y gastric bypass (RYGB). MATERIALS AND METHODS We performed a retrospective analysis of patients undergoing laparoscopic RYGB (LRYGB) between 2008 and 2018. Chi-square, Fisher's exact, or Wilcoxon rank-sum tests were used to compare outcomes. Concomitant CCY was performed on a selective basis. RESULTS Three thousand and four patients underwent a RYGB (LRYGB n = 2458, open RYGB n = 546). Fifty-two percent (n = 1670) of patients had undergone CCY at any stage. Thirty-one percent of patients (n = 933) had CCY prior to RYGB, 13% (n = 403) had a concomitant CCY and 13% (n = 214) of the remainder required interval CCY. In the LRYGB subgroup, 29.9% (n = 735) had a prior CCY; 12.9% (n = 202) of those with an in situ gallbladder required interval CCY. Those who underwent concomitant CCY/LRYGB (n = 328) were compared with LRYGB alone (n = 1231). The concomitant CCY group was significantly older and had higher percentage of females, higher preoperative BMI, higher Charlson Comorbidity Index, and a higher medication count. There was no significant difference in BMI nadir, length of stay, complications, or mortality. Interval CCY had a higher incidence of CCY-related complications. CONCLUSION Our study suggests a higher percentage of bariatric patients with in situ gallbladders will undergo interval CCY than documented in recently published guidelines. Concomitant CCY can be performed without an increase in length of stay or complications. Interval CCY may be associated with a higher complication rate.
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Sakran N, Dar R, Assalia A, Neeman Z, Farraj M, Sherf-Dagan S, Gralnek IM, Hazzan R, Mokary SE, Nevo-Aboody H, Dola T, Kaplan U, Hershko D. The use of Ursolit for gallstone prophylaxis following bariatric surgery: a randomized-controlled trial. Updates Surg 2020; 72:1125-1133. [PMID: 32666477 DOI: 10.1007/s13304-020-00850-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although bariatric surgery (BS) predisposes patients to development of gallstone formation, a preventive strategy is still in debate. AIM To compare the incidence of gallstone formation between patients treated with ursodeoxycholic acid (UDCA) vs. placebo for a duration of 6 months following BS. METHODS This multicenter randomized, double-blind controlled trial entails treatment with UDCA vs. an identical-looking placebo. The primary outcome was gallstone formation, as measured by abdominal ultrasound. RESULTS The data of 209 subjects were enrolled in the study, and 92 subjects completed the study and were analyzed (n = 46 for each study group). The high dropout rate was mainly due to difficulties in adding more medications and swallowing the pill. Among the subjects who completed the study, 77.2% were women, and their mean age and pre-surgery BMI were 42.2 ± 10.2 years and 44.4 ± 6.1 kg/m2, respectively. Gallstone formation was recorded in 45.7% (n = 21) vs. 23.9% (n = 11) of subjects among placebo vs. UDCA groups, respectively, p = 0.029. Subgroup-analysis, according to surgery type, found that the results were significant only for SG subjects (p = 0.041), although the same trend was observed for OAGB/RYGB. Excess Weight Loss percent (%EWL) at 6 months post-surgery was 66.0 ± 17.1% vs. 71.8 ± 19.5% for the placebo and UDCA groups, respectively; p = 0.136. A trend towards a reduction in prescribed comorbidity medications was noted within-groups during the follow-up period, as compared to baseline, with no between-group differences (p ≥ 0.246). Moreover, no between-group differences were found for blood test results (p ≥ 0.063 for all). CONCLUSION Administration of UDCA significantly decreased gallstone formation at 6 months at following BS. CLINICALTRIALS. GOV NUMBER NCT02319629.
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Affiliation(s)
- Nasser Sakran
- Department of Surgery, Emek Medical Center, 21 Izhak Rabin Blvd, 1834111, Afula, Israel. .,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Ron Dar
- Department of Surgery, Emek Medical Center, 21 Izhak Rabin Blvd, 1834111, Afula, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ahmad Assalia
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ziv Neeman
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Medical Imaging Institute and Nuclear Medicine, Emek Medical Center, Afula, Israel
| | - Moaad Farraj
- Department of Surgery, Galilee Medical Center, Nahariya, Israel
| | - Shiri Sherf-Dagan
- Department of Nutritional Sciences, School of Health Sciences, Ariel University, Ariel, Israel.,Department of Nutrition, Assuta Medical Center, Tel-Aviv, Israel
| | - Ian M Gralnek
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Ellen and Pinchas Mamber Institute of Gastroenterology, Hepatology, and Nutrition, Emek Medical Center, Afula, Israel
| | - Rawi Hazzan
- Ellen and Pinchas Mamber Institute of Gastroenterology, Hepatology, and Nutrition, Emek Medical Center, Afula, Israel
| | - Shams Eldin Mokary
- Department of Surgery, Emek Medical Center, 21 Izhak Rabin Blvd, 1834111, Afula, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hadar Nevo-Aboody
- Department of Surgery, Emek Medical Center, 21 Izhak Rabin Blvd, 1834111, Afula, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Tamar Dola
- Department of Surgery, Emek Medical Center, 21 Izhak Rabin Blvd, 1834111, Afula, Israel
| | - Uri Kaplan
- Department of Surgery, Emek Medical Center, 21 Izhak Rabin Blvd, 1834111, Afula, Israel
| | - Dan Hershko
- Department of Surgery, Emek Medical Center, 21 Izhak Rabin Blvd, 1834111, Afula, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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The effect of concomitant cholecystectomy and sleeve gastrectomy on morbidity in high-risk obese patients with symptomatic gallstones. Wideochir Inne Tech Maloinwazyjne 2019; 14:237-241. [PMID: 31118989 PMCID: PMC6528126 DOI: 10.5114/wiitm.2019.81686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction Obesity is an independent risk factor for gallstones. In obese patients, gallstone is more symptomatic than in non-obese people. Aim To present the early results of laparoscopic sleeve gastrectomy (LSG) and concomitant cholecystectomy (CC) performed in patients with symptomatic gallstone accompanied by at least one additional systemic disease to obesity and to investigate its effect on morbidity. Material and methods Patients undergoing sleeve gastrectomy for morbid obesity between January 2016 and August 2018 were retrospectively studied. Twenty-seven patients who underwent laparoscopic sleeve gastrectomy and concomitant cholecystectomy due to symptomatic gallstone stones were included in this study. The patients were divided into two groups according to the applied surgical technique: laparoscopic sleeve gastrectomy and concomitant cholecystectomy (n = 27) and laparoscopic sleeve gastrectomy (n = 70). The results of an additional operation on these patients and their perioperative complications were evaluated. Results A total of 97 patients were included in the study. The mean age of the patients was 40.58 ±10.36 years. There was no statistically significant difference between groups in terms of complications (p = 0.669). The difference in the duration of the operation was statistically significant (p < 0.001). Conclusions Concomitant cholecystectomy may be presented as an alternative surgical procedure due to the demonstration that concomitant cholecystectomy can be performed safely in comorbid obese patients, with a risk of becoming symptomatic in the rest of life at a certain rate, and low risk of complications in asymptomatic patients.
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15
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Wood SG, Kumar SB, Dewey E, Lin MY, Carter JT. Safety of concomitant cholecystectomy with laparoscopic sleeve gastrectomy and gastric bypass: a MBSAQIP analysis. Surg Obes Relat Dis 2019; 15:864-870. [PMID: 31060907 DOI: 10.1016/j.soard.2019.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/24/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Gallstone disease occurs more commonly in the obese population and is often diagnosed during the preoperative evaluation for bariatric surgery. OBJECTIVES This study analyzed outcomes of laparoscopic gastric bypass (LGB) and laparoscopic sleeve gastrectomy (SG), with and without cholecystectomy (LC), using data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. SETTING Patients reported to Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers in the United States and Canada in 2015. METHODS All cases of LGB and SG, with and without LC, were analyzed. A 1:1 propensity-matched cohort was created for both SG and LGB, with and without concomitant LC. Multivariate logistic regression stratified by procedure was used to identify predictors of major complications after SG and LGB, using concomitant LC as a predictor. We also constructed a model for surgical site infections (SSIs) for SG group. RESULTS Of 98,292 sleeve operations, 2046 (2%) had concomitant LC. Of 44,427 bypass operations, 1426 (3%) had concomitant LC. For the sleeve group, concomitant LC increased operative time by an average of 27 minutes but did not affect length of stay, mortality, or major complications. Concomitant LC was associated with increased SSI (1% versus .4%) and need for reoperation (1.6% versus .7%) in univariate models. After adjusting for other predictors, concomitant LC was associated with increased risk for SSI (odds ratio 2.5, confidence interval 1.0-5.9, P = .04). For the bypass group, concomitant LC increased operative time by an average of 28 minutes to the operation, and postoperative length of stay averaged ∼5 hours longer (2.4 versus 2.2 d, P = .03). Thirty-day complications were similar between the groups. On multivariate analysis, concomitant LC was not a significant risk factor for major complications. Only operative time was an independent factor for major complications. CONCLUSIONS Concomitant LC with laparoscopic sleeve gastrectomy or gastric bypass did not affect mortality or risk of major complication. For sleeve patients, concomitant LC was associated with a .6% increased risk (.4% to 1.0%) of SSI. Concomitant LC with laparoscopic sleeve gastrectomy or gastric bypass is safe when indicated for gallstone disease.
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Affiliation(s)
- Stephanie G Wood
- Department of Surgery, Oregon Health and Science University, Portland, Oregon.
| | - Sandhya B Kumar
- Department of Surgery, University of California, San Francisco, California
| | - Elizabeth Dewey
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Matthew Y Lin
- Department of Surgery, University of California, San Francisco, California
| | - Jonathan T Carter
- Department of Surgery, University of California, San Francisco, California
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17
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Minhem MA, Safadi BY, Tamim H, Mailhac A, Alami RS. Does intraoperative endoscopy decrease complications after bariatric surgery? Analysis of American College of Surgeons National Surgical Quality Improvement Program database. Surg Endosc 2019; 33:3629-3634. [PMID: 30706152 DOI: 10.1007/s00464-018-06650-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/24/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Intraoperative endoscopy (IOE) has been proposed to decrease serious complications following bariatric surgeries such as leaks, bleeding, and stenosis. Such complications can lead to sepsis and eventually can be fatal. We aim to compare major postoperative complications in patients with and without IOE. METHODS Data from the American College of Surgeons National Surgical Quality Improvement Program database years 2011 till 2016 were used to identify laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) patients. We compared outcomes of IOE and non-IOE using bivariate and multivariate analysis. Thirty-day outcomes included sepsis, organ space infection, unplanned reoperations, unplanned readmissions, prolonged hospital stay, bleeding, and mortality. RESULTS Out of 62,805 cases of LSG and 50,047 cases of LRYGB, 17.9%, and 19.7% had IOE, respectively. Endoscopy-assisted LSG was associated with a decrease in sepsis [0.37% vs. 0.21%, adjusted odds ratio (AOR) = 0.55 (0.36, 0.84)], unplanned reoperation [0.58% vs. 0.38%, AOR = 0.61 (0.44, 0.85)], prolonged hospital stay [14.9% vs. 14.0%, AOR = 0.87 (0.82, 0.92)], and composite complications [1.43% vs. 1.17%, AOR = 0.78 (0.65, 0.94)]. Outcomes after LRYGB were similar in both groups, except for decreased prolonged hospital stay with IOE [22.4% vs. 20.6%, AOR = 0.89 (0.84, 0.94)]. CONCLUSIONS IOE is generally underutilized in baraitric procedures. IOE is associated with decreased risk of postoperative complications particularly sepsis, unplanned reoperations, prolonged hospital stay, and composite complications after LSG; and hospital stay after LRYGB. Large multicenter prospective studies are needed to explore the benefits of IOE in bariatric surgery, particularly the intermediate or long-term benefits.
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Affiliation(s)
- Mohamad A Minhem
- Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, 1107 2020, Beirut, Lebanon
| | - Bassem Y Safadi
- Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, 1107 2020, Beirut, Lebanon
| | - Hani Tamim
- Biostatistics Unit, Clinical Research Institute, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aurelie Mailhac
- Biostatistics Unit, Clinical Research Institute, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ramzi S Alami
- Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, 1107 2020, Beirut, Lebanon.
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Tustumi F, Bernardo WM, Santo MA, Cecconello I. Cholecystectomy in Patients Submitted to Bariatric Procedure: A Systematic Review and Meta-analysis. Obes Surg 2018; 28:3312-3320. [DOI: 10.1007/s11695-018-3443-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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19
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Juo YY, Khrucharoen U, Chen Y, Sanaiha Y, Benharash P, Dutson E. Cost analysis and risk factors for interval cholecystectomy after bariatric surgery: a national study. Surg Obes Relat Dis 2018. [DOI: 10.1016/j.soard.2017.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Sinnamon AJ, Neuwirth MG, Vining CC, Sharoky CE, Yang YX, Kelz RR, Fraker DL, Roses RE, Karakousis GC. Prophylactic Cholecystectomy at Time of Surgery for Small Bowel Neuroendocrine Tumor Does Not Increase Postoperative Morbidity. Ann Surg Oncol 2017; 25:239-245. [PMID: 29067602 DOI: 10.1245/s10434-017-6093-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prophylactic cholecystectomy at time of surgery for small bowel neuroendocrine tumor (SBNET) has been advocated, as these patients often go on to require somatostatin analogue therapy, which is known to increase risk of cholestasis and associated complications. Little is known regarding patterns of adoption of this practice or its associated morbidity. METHODS The American College of Surgeons National Surgical Quality Improvement Program database (2008-2014) was queried to identify patients who underwent SBNET resection. The risk differences of morbidity and mortality associated with performance of concurrent cholecystectomy were determined with multivariable adjustment for confounders. RESULTS Among 1300 patients who underwent SBNET resection, 144 (11.1%) underwent concurrent cholecystectomy. Median age of patients undergoing cholecystectomy was 62 years [interquartile range (IQR) 52-69 years], and 75 were male. They more commonly had disseminated cancer (36.1 vs. 11.6%, p < 0.001) or SBNET located in duodenum (10.4 vs. 4.9%, p = 0.045) without difference in other baseline characteristics. Operative time was significantly longer in the cholecystectomy group (median 172 vs. 123 min, p < 0.001). Rate of postoperative morbidity was not significantly different between cholecystectomy and no-cholecystectomy groups (11.8 vs. 11.1%, p = 0.79). After adjustment for confounding, the risk difference of morbidity attributable to cholecystectomy was + 0.4% [95% confidence interval (CI) - 4.9 to + 5.6%]. Mortality within 30 days was not significantly different between cholecystectomy and no-cholecystectomy groups (1.4 vs. 0.6%, p = 0.29). CONCLUSIONS Concurrent cholecystectomy at time of resection of SBNET is not associated with higher morbidity or mortality yet is performed in a minority of patients. Prospective study can identify which patients may derive benefit from this approach.
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Affiliation(s)
- Andrew J Sinnamon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. .,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Madalyn G Neuwirth
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Charles C Vining
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Catherine E Sharoky
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Yu-Xiao Yang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas L Fraker
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert E Roses
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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