Gallbladder management in obesity surgery

被引：65

作者：

Mason, EE ^{[1
]}

Renquist, KE ^{[1
]}

Angus, LDG ^{[1
]}

Baker, DJ ^{[1
]}

Baker, JW ^{[1
]}

Betcher, RA ^{[1
]}

Cleator, AGM ^{[1
]}

Clough, DM ^{[1
]}

Cox, S ^{[1
]}

Doherty, C ^{[1
]}

Drew, R ^{[1
]}

Ediger, AJ ^{[1
]}

Fobi, MAL ^{[1
]}

Gleysteen, JJ ^{[1
]}

Halverson, JD ^{[1
]}

Jaroch, MT ^{[1
]}

Jones, KB ^{[1
]}

Lee, H ^{[1
]}

LePort, P ^{[1
]}

Lirio, OC ^{[1
]}

MacPherson, BH ^{[1
]}

Maher, JW ^{[1
]}

Marema, RI ^{[1
]}

Mason, EE ^{[1
]}

Murphy, LJ ^{[1
]}

Popoola, D ^{[1
]}

Rumsey, EW ^{[1
]}

Rupp, W ^{[1
]}

Schechner, SA ^{[1
]}

Schwartz, M ^{[1
]}

Scott, TC ^{[1
]}

Stoner, JA ^{[1
]}

Tanaka, LK ^{[1
]}

Zorn, GG ^{[1
]}

机构：

[1] Univ Iowa, Coll Med, Dept Surg, Int Bariatr Surg Registry, Iowa City, IA 52242 USA

来源：

OBESITY SURGERY | 2002年 / 12卷 / 02期

关键词：

morbid obesity; bariatric surgery; cholecystectomy; standard of care;

D O I：

10.1381/096089202762552395

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background: In the 1980s, some surgeons recommended routine cholecystectomy for patients undergoing bariatric surgery. This was based on the high prevalence of gallstones in the obese and concern that rapid weight loss would increase the risk of gallbladder disease. Others recommended waiting for a lower weight and a definite need. With increasing prevalence and severity of obesity and increased use of gastric reduction surgery for weight control, it seemed appropriate to review the current standard of care for cholecystectomy. A survey was also made of ursodeoxycholic acid usage for prevention of gallstone formation. Methods: Data collected from active contributors for the 28th Report of the International Bariatric Surgery Registry (IBSR) were examined. Two questionnaires were also sent to members of the American Society for Bariatric, Surgery (ASBS). The first (Q1) asked about the Indications for cholecystectomy. The second (Q2) asked about ursodeoxycholic acid usage for prevention of gallstone formation during rapid weight loss following surgical treatment of obesity. Results:There has been an increase in concurrent cholecystectomy during the last 15 years. Some of this is due to a shift from simple gastric restrictive operations to gastric bypass with gastric restriction. When the most extensive bypass of intestine is used, as in distal Roux-en-Y gastric bypass (RYGBP-X) or biliopancreatic diversion with a duodenal switch (BPD-DS), all patients were reported to have undergone cholecystectomy. Only 30% of surgeons performing standard Roux-en-Y gastric bypass (RYGBP) remove normal-appearing gallbladders. Ursodeoxycholic acid is used to prevent gallstone formation in one-third of patients when a normal-appearing gallbladder is left in place. Conclusions: Prophylactic cholecystectomy is left to the discretion of the surgeon when RYGBP is used. There has been an increase in cholecystectomy and malabsorptive operations during the last 15 years. When most of the small bowel is bypassed, all remaining gallbladders are removed. For patients with simple restriction operations, normal-appearing gallbladders are usually left in place. Urso-deoxycholic acid during rapid weight loss for prevention of gallstone formation is used in one-third of patients with remaining gallbladders.

引用

页码：222 / 229

页数：8

共 10 条

[1] GALLBLADDER-DISEASE IN THE MORBIDLY OBESE [J].

AMARAL, JF ;

THOMPSON, WR .

AMERICAN JOURNAL OF SURGERY, 1985, 149 (04) :551-557

[2] COEXISTENCE OF GALLBLADDER-DISEASE AND MORBID-OBESITY [J].

CALHOUN, R ;

WILLBANKS, O .

AMERICAN JOURNAL OF SURGERY, 1987, 154 (06) :655-658

[3]

DEITEL M, 1987, SURG GYNECOL OBSTET, V164, P549

[4] ANALYSIS OF GALLBLADDER BILE IN MORBID OBESITY [J].

FREEMAN, JB ;

MEYER, PD ;

PRINTEN, KJ ;

MASON, EE ;

DENBESTEN, L .

AMERICAN JOURNAL OF SURGERY, 1975, 129 (02) :163-166

[5]

MABIE TM, 1976, SURGERY, V79, P460

[6] Informed consent for obesity surgery [J].

Mason, EE ;

Hesson, WW .

OBESITY SURGERY, 1998, 8 (04) :419-428

[7]

SCHMIDT JH, 1988, AM SURGEON, V54, P269

[8] BILIO-PANCREATIC BYPASS FOR OBESITY .2. INITIAL EXPERIENCE IN MAN [J].

SCOPINARO, N ;

GIANETTA, E ;

CIVALLERI, D ;

BONALUMI, U ;

BACHI, V .

BRITISH JOURNAL OF SURGERY, 1979, 66 (09) :618-620

[9] 2 YEARS OF CLINICAL-EXPERIENCE WITH BILIOPANCREATIC BYPASS FOR OBESITY [J].

SCOPINARO, N ;

GIANETTA, E ;

CIVALLERI, D ;

BONALUMI, U ;

BACHI, V .

AMERICAN JOURNAL OF CLINICAL NUTRITION, 1980, 33 (02) :506-514

[10] A MULTICENTER, PLACEBO-CONTROLLED, RANDOMIZED, DOUBLE-BLIND, PROSPECTIVE TRIAL OF PROPHYLACTIC URSODIOL FOR THE PREVENTION OF GALLSTONE FORMATION FOLLOWING GASTRIC-BYPASS-INDUCED RAPID WEIGHT-LOSS [J].

SUGERMAN, HJ ;

BREWER, WH ;

SHIFFMAN, ML ;

BROLIN, RE ;

FOBI, MAL ;

LINNER, JH ;

MACDONALD, KG ;

MACGREGOR, AM ;

MARTIN, LF ;

ORAMSMITH, JC ;

POPOOLA, D ;

SCHIRMER, BD ;

VICKERS, FF .

AMERICAN JOURNAL OF SURGERY, 1995, 169 (01) :91-97

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