Month: February 2015
The indication for concurrent cholecystectomy (gall bladder removal) with weight loss surgery is not clear. There is some scientific literature that recommends against cholecystectomy at the time of the Gastric Bypass RNY operation. To the best of my knowledge, there is no such studies looking specifically at the indication of cholecystectomy with duodenal switch operation.
My rationale for doing a cholecystectomy with every Duodenal Switch patient is that there is not only higher incidence of asymptomatic cholecystitis present but also due to limited access to the biliary tree. The transection of the duodenum and removal of the greater curvature of the stomach both limit access to the biliary tree. Additionally, the patient recovering from weight loss surgery, may not be in the best nutritional status to undergo a subsequent operation for gallbladder removal. A second surgery could add to nutritional issues due to protein needs for healing, risk of infection, hernia formation, etc.
From a technical aspects, in Duodenal Switch operation, the liver and the gall bladder need to be elevated in order to expose the anterior surface of the duodenum where the transection of the duodenum is performed. Doing a cholecystectomy at the time of the duodenal switch operation, more often than not only add a few minutes to the operation. In the majority of patients, long-term this saves them the potential need for a subsequent operation at a later date should they develop gallstones or gall bladder attack.
When I perform a Sleeve Gastrectomy the duodenum is not transected or dissected, and thus I do not remove the gall bladder when doing sleeve gastrectomy. I do, however, remove the gall bladder when doing primary Duodenal Switch for revision from a Gastric Bypass RNY to the Duodenal Switch operation.