For the study, researchers examined data on about 79,000 patients
who underwent cholecystectomy and almost 36,000 who had Roux-en-Y
gastric bypass. Most of these patients only had one of the
procedures, but about 2,650 had both surgeries either simultaneously
Among patients who had both surgeries, people who had the
weight-loss operations first were 35% more likely to have
complications than individuals who had the gallbladder surgery
first, the study found.
Having both operations at the same time was twice as likely to lead
to complications as having the gallbladder procedure done first,
according to the October 18 online report in British Journal of
“For patients with symptomatic gallstones and obesity (i.e.,
considering both cholecystectomy and gastric bypass),
cholecystectomy should preferentially be performed before gastric
bypass,” said lead study author Dr. Viktor Wanjura, a surgeon at
Orebro University Hospital in Sweden.
But gallstones that don’t produce symptoms “should never be treated
surgically,” Wanjura said by email. “Doing so would introduce
unnecessary complications in many patients that would never be
troubled by their gallstones at all during their lifetime.”
The study wasn’t a controlled experiment designed to prove whether
or how doing one of the two procedures before the other one might
influence complication rates.
It’s possible that patients might have nutritional deficits after
weight-loss surgeries that might contribute to a higher complication
rate with the gallstone removal procedures, Wanjura said. But more
research is needed to clearly understand the cause of complications.
When researchers looked at all of the patients in the study,
including the majority of people who only had gallbladder or
weight-loss procedures but not both, they found 2.3% of people had
complications with gallbladder operations and 2.7% had complications
with weight-loss surgery.
[to top of second column]
Among people who had both procedures, roughly 13% had complications
regardless of which operation came first or second.
When gallbladder operations were done after weight-loss surgery,
however, almost 16% of patients had complications, compared with 8%
of patients when the gallbladder operation was done first.
Even though the study doesn’t explain why complication rates
differed, the results suggest that it makes sense for patients to
discuss the ideal order of both operations with doctors before they
have surgery, said Dr. Anita Courcoulas, chief of minimally invasive
bariatric and general surgery at the University of Pittsburgh
“I think patients need to be aware that although gallbladder surgery
is one of the most common abdominal operations performed, that
complications are possible especially in people who also have the
diseases of obesity, diabetes, and others,” Courcoulas, who wasn’t
involved in the study, said by email.
“A patient and their surgeon should have an open and shared
decision-making conversation to together weigh the risks and
benefits of the timing of both gallbladder and bariatric surgery,”
Courcoulas added. “These decisions are best individualized, taking
into account the patient’s symptoms, anatomy, and other risks for
Br J Surg 2017.
[© 2017 Thomson Reuters. All rights
Copyright 2017 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.