The patients who received LAGB had a shorter median time to cholecystectomy (4 months) than did those who received open (14 months) or laparoscopic RYGB (9 months), “which was somewhat perplexing and we're still trying to figure out why this is the case,” Dr. Ellner said.
Nearly all of the delayed cholecystectomies (37 of 38) in Dr. Ellner's study were performed laparoscopically. Four patients had choledocholithiasis, and one had gallstone pancreatitis.
In both studies, the patients who participated because they did not have a previous cholecystectomy may represent a preselected population with a lower risk for gallbladder pathology, the speakers noted.
The incidence of symptomatic biliary disease “will grow considerably” during the following decades from the 9% that was detected in the “very, very short follow-up” of Dr. Ellner's study, cautioned audience member Dr. Michael G. Sarr of the Mayo Clinic, Rochester, Minn. “That doesn't mean that we should be taking everyone's gallbladder out if you do [bariatric surgery] laparoscopically, but if you do [open surgery], I don't see any reason not to” take the gallbladder out.