American Society for Metabolic and Bariatric Surgery

View all recommendations from this society

Released June 25, 2015

Don’t routinely remove the gallbladder unless clinically indicated.

Although infrequent, the incidence of bile duct injury rates has increased since the introduction of laparoscopic cholecystectomy. Major and even minor bile duct injuries can result in life-altering complications with significant morbidity and cost. Removal of normal and asymptomatic gallbladders at the time of bariatric surgery has not been shown to be necessary and may expose a patient to possible risk of complications without proven benefit.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Society for Metabolic and Bariatric Surgery (ASMBS) initially solicited expert opinion from surgeons who are members of the Clinical Issues Committee. This committee is responsible for drafting guidelines and position statements for the ASMBS. We also received input from the Executive Council of the ASMBS to narrow the original list down to those with highest priority.

For ASMBS’ disclosure and conflict of interest policy, please visit www.asmbs.org.

Sources

Tsirline VB, Keilani ZM, El Djouzi S, Phillips RC, Kuwada TS, Gersin K, Simms C, Stefanidis D. How frequently and when do patients undergo cholecystectomy after bariatric surgery? Surg Obes Relat Dis. 2014 Mar-Apr;10(2):313-21.

Moon RC, Teixeira AF, DuCoin C, Varnadore S, Jawad MA. Comparison of cholecystectomy cases after Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric banding. Surg Obes Relat Dis. 2014 Jan-Feb;10(1):64-8.

Grover BT, Kothari SN. Biliary issues in the bariatric population. Surg Clin North Am. 2014 Apr;94(2):413-25.

Patel JA, Patel NA, Piper GL, Smith DE 3rd, Malhotra G, Colella JJ. Perioperative management of cholelithiasis in patients presenting for laparoscopic Roux-en-Y gastric bypass: have we reached a consensus? Am Surg. 2009 Jun;75(6):470-6.

Warschkow R, Tarantino I, Ukegjini K, Beutner U, Güller U, Schmied BM, Müller SA, Schultes B, Thurnheer M. Concomitant cholecystectomy during laparoscopic Roux-en-Y gastric bypass in obese patients is not justified: a meta-analysis. Obes Surg. 2013 Mar;23(3):397-407.

D’Hondt M, Sergeant G, Deylgat B, Devriendt D, Van Rooy F, Vansteenkiste F. Prophylactic cholecystectomy, a mandatory step in morbidly obese patients undergoing laparoscopic Roux-en-Y gastric bypass? J Gastrointest Surg. 2011 Sep;15(9):1532-6.

Li VK, Pulido N, Fajnwaks P, Szomstein S, Rosenthal R, Martinez-Duartez P. Predictors of gallstone formation after bariatric surgery: a multivariate analysis of risk factors comparing gastric bypass, gastric banding, and sleeve gastrectomy. Surg Endosc. 2009 Jul;23(7):1640-4.

Ellner SJ, Myers TT, Piorkowski JR, Mavanur AA, Barba CA. Routine cholecystectomy is not mandatory during morbid obesity surgery. Surg Obes Relat Dis. 2007 Jul-Aug;3(4):456-60.

Portenier DD, Grant JP, Blackwood HS, Pryor A, McMahon RL, DeMaria E. Expectant management of the asymptomatic gallbladder at Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007 Jul-Aug;3(4):476–9.

Papasavas PK, Gagné DJ, Ceppa FA, Caushaj PF. Routine gallbladder screening not necessary in patients undergoing laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2006 Jan-Feb;2(1):41-6.

Patel KR, White SC, Tejirian T, Han SH, Russell D, Vira D, Liao L, Patel KB, Gracia C, Haigh P, Dutson E, Mehran A. Gallbladder management during laparoscopic Roux-en-Y gastric bypass surgery: routine preoperative screening for gallstones and postoperative prophylactic medical treatment are not necessary. Am Surg. 2006 Oct;72(10):857-61.

Swartz DE, Felix EL. Elective cholecystectomy after Roux-en-Y gastric bypass: why should asymptomatic gallstones be treated differently in morbidly obese patients? Surg Obes Relat Dis. 2005 Nov-Dec;1(6):555-60.

Caruana JA, McCabe MN, Smith AD, Camara DS, Mercer MA, Gillespie JA. Incidence of symptomatic gallstones after gastric bypass: is prophylactic treatment really necessary? Surg Obes Relat Dis. 2005 Nov-Dec;1(6):564-7.

Villegas L, Schneider B, Provost D, Chang C, Scott D, Sims T, Hill L, Hynan L, Jones D. Is routine cholecystectomy required during laparoscopic gastric bypass? Obes Surg. 2004 Feb;14(1):60-6.

Hamad GG, Ikramuddin S, Gourash WF, Schauer PR. Elective cholecystectomy during laparoscopic Roux-en-Y gastric bypass: is it worth the wait? Obes Surg 2003 Feb;13(1):76–81.

Sugerman HJ, Brewer WH, Shiffman ML, Brolin RE, Fobi MA, Linner JH, MacDonald KG, MacGregor AM, Martin LF, Oram-Smith JC, Popoola D, Schirmer BD, Vickers FF. 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. Am J Surg. 1995 Jan;169(1):91-6.