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Gallstone Prophylaxis Is Called Costly And Unwarranted After Gastric Bypass


 

ORLANDO — Cholecystectomy or 6 months of prophylactic medication to prevent gallstones after gastric bypass surgery is unwarranted for most patients and is expensive, according to results of a study presented by Joseph A. Caruana, M.D., at the annual meeting of the American Society for Bariatric Surgery.

Dr. Caruana and his associates studied 100 women and 25 men after open Roux-en-Y gastric bypass. None of the participants received ursodeoxycholic acid, a medication often used to prevent gallstones during rapid loss of weight. All procedures were performed at the Sisters of Charity Hospital in Buffalo, N.Y., from June 2000 to July 2002. Participants did not have palpable gallstones at the time of surgery, and required at least 16 months of follow-up for inclusion in the study.

A total of 10 patients (8%) developed symptomatic gallstones that required cholecystectomy. Nine of these 10 women had laparoscopic cholecystectomy, and 1 had an open procedure. There were no serious complications from the gallstones or cholecystectomies, said Dr. Caruana, a laparoscopy fellow at the Sisters of Charity Hospital.

“Prophylactic cholecystectomy would have been unnecessary in 115 patients,” Dr. Caruana said. “The risk and cost of prophylactic cholecystectomy outweigh the benefits. Concomitant cholecystectomy is indicated only when stones are detected pre- or intraoperatively.”

The incidence of symptomatic stones in the first two postoperative years was about 6% per year, Dr. Caruana said. “Most newly formed stones after gastric bypass are asymptomatic.” He added that most patients with asymptomatic stones will remain asymptomatic during their lifetimes.

Many surgeons have proposed prevention with a cholecystectomy at the time of gastric bypass surgery (Obes. Surg. 2004;14:763–5). However, “most general surgeons would not remove the gallbladder during other procedures without the presence of stones,” Dr. Caruana said.

Rapid weight loss after gastric bypass surgery can cause gallstones to form in up to 50% of patients, Dr. Caruana noted. For this reason, some experts recommend 6 months of ursodeoxycholic acid. A 6-month course of ursodeoxycholic acid for all 125 participants in the study would have cost $56,250, he said.

A better use of ursodeoxycholic acid might be for symptomatic patients who refuse surgery, he suggested.

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