Concomitant cholecystectomy during laparoscopic Roux-en-Y gastric bypass in obese patients is not justified: a meta-analysis.
BACKGROUND To date, published reports have shown an increased length of hospital stay and increased morbidity for patients undergoing simultaneous cholecystectomy during Roux-en-Y gastric bypass (RYGB). We hypothesized that our experience would not show such adverse outcomes. METHODS All RYGB procedures (n = 752) performed by 1 surgeon at our institution from 1995 to 2006 were reviewed for demographic data, operative data, and postoperative outcomes. A laparoscopic approach (LRYGB) was used for 438 procedures. The data from a prospectively gathered institutional database were retrospectively compared using standard statistical analysis. RESULTS Comparing LRYGB with cholecystectomy to LRYGB without cholecystectomy, the operative time was significantly longer (198.4 +/- 61.9 versus 177.7 +/- 57.7 min, P = .001), but the mean hospital stay (3.3 +/- 5.5 versus 2.9 +/- 6.1 d, P = .555), postoperative complication rate (18.3% versus 18.5%, P = .100), and postoperative mortality (0% and .6%, P = 1.000) were not different between the 2 groups. Comparing the open RYGB patients with and without simultaneous cholecystectomy, the operative time was similarly longer (223.4 +/- 63.9 versus 203.5 +/- 57.3 min, P = .005), and the mean hospital stay (5.0 +/- 3.7 versus 4.7 +/- 5.9 d, P = .644), postoperative complication rate (61.4% versus 55.2%, P = .293), and postoperative mortality rate (1.6% versus 2.4%, P = .685) were not different between the 2 groups. CONCLUSION Although it took, on average, 20 minutes longer, cholecystectomy can be safely added to RYGB without increasing the hospital stay, postoperative morbidity, or mortality in both laparoscopic and open surgery using comparable operative techniques. We recommend routine simultaneous cholecystectomy be performed for patients with documented gallstones during RYGB.