EP.TH.210Our Take on Prophylactic Cholecytectomy in Patients Undergoing Bariatric Laparoscopic Roux En Y Gastric Bypass (Lrygb)

Aim The concept of prophylactic cholecystectomy in bariatric patients undergoing laparoscopic roux en y gastric bypass despite extensive discussion remains controversial. We aim to resolve this controversy by our observational study. Method Data extracted from our prospective Bariatric and theater database between 2012 and 2018 of patients having undergone roux en Y bypass and laparoscopic cholecytectomy in a retrospective manner. The primary endpoint was determining the incidence of laparoscopic cholecystectomy in bariatric bypass patients. The second endpoint of data analysis was to compare the outcomes between post laparoscopic roux en y gastric bypass and laparoscopic cholecystectomy in non bariatric. Results Incidence of laparoscopic cholecystectomy in 511 LRYGB patients was 19.17%. These were performed before (9.70%), after (7.20%) and concomitantly (2.15%). Ultrasound was done in 71.60% of patients of which 28.10% had evidence of Gallstones. MRCP was done in 1.56% for suspected CBD stone before LRYGB and 4.10% after LRYGB. Only 2(0.39%) patients required a laparoscopic assisted ERCP. Over all complications from Laparoscopic cholecytectomy performed after or concomitantly with LRYGB was similar to the non bariatric cohort. Conclusion We reported a low incidence of post and concomitant laparoscopic cholecystectomy There was no statistical deference in post operative complications from laparoscopic cholesystectomy between LRYGB and non bariatric population. To conclude there is no evidence support prophylactic cholecystectomy. However, a randomized controlled trial should be considered to support our conclusion.

Prophylactic cholecystectomy is not mandatory in patients candidate to the resection for small intestine neuroendocrine neoplasms: a propensity score-matched and cost-minimization analysis

To evaluate two competitive strategies in patients undergoing resection of Small-intestine neuroendocrine neoplasms (Si-NEN): prophylactic cholecystectomy (PC) versus On-demand delayed (OC) cholecystectomy. None comparative studies are available. This is a retrospective study based on 247 Si-NENs candidates for the primary tumor resection. Patients were divided into two arms: PC and OC. Propensity score matching was performed, reporting the d value. The primary outcome was the rehospitalization rate for any cause. The secondary endpoints were: the rehospitalization rate for biliary stone disease (BSD), the mean number of rehospitalization (any cause and BSD), the complication rate (all and severe). A P value < 0.05 was considered significant, and the number needed to treat (NNT) < 10 was considered clinically relevant. Before matching, 52 (21.1%) were in the PC arm and 195 (78.9%) in the OC group. The two arms have a sub-optimal balance for age (d = 0.575), symptoms (d = 0.661), ENETS TNM stage (d = 0.661). After matching, we included 52 patients in PC and 104 in OC one. The two groups are well balanced (all d values < 0.5). The rehospitalization rate was similar in the two groups (36% vs 31; P = 0.594; NNT = 21). The rehospitalization rate for BSD was lower in the PC arm than OC one (0% vs 7%) without statistical significance (P = 0.096) and relevance (NNT = 15). The mean number of readmission (any cause and BSD) and the complication rate (all and severe) were similar. PC was not mandatory in patients having Si-NEN and candidates to the resection of primary tumors.

Management of Porcelain Gallbladder, Its Risk Factors, and Complications: A Review

The porcelain gallbladder condition describes gallbladder calcification. While gallbladder calcification is believed to increase the risk of developing gallbladder cancer, recent reports have shown that the malignancy risk is much lower than previously reported. Symptomatic patients with porcelain gallbladder should be recommended for cholecystectomy, but the management of asymptomatic patients is debatable. Based on recent evidence, prophylactic cholecystectomy is not routinely recommended in all patients with porcelain gallbladder. From the assessment of the current literature, there are three essential factors in the management of patients with porcelain gallbladder: 1) symptoms or complications of gallbladder disease, 2) calcification pattern and 3) patient age and comorbidities. Patients who do not undergo cholecystectomy should be educated about the symptoms of gallbladder diseases, and a thorough discussion is essential between patients and clinicians.

Risk factors for the onset of gallbladder cancer: a review

Gallbladder cancer (GBC) is the most common malignancy of the biliary system in clinic, which has the characteristics of insidious onset and high degree of malignancy. Most patients have progressed to an advanced stage when they are diagnosed. Early identification of risk factors of the onset of gallbladder cancer and active intervention are the key to improve the rate of early diagnosis and prognosis of gallbladder cancer. At present, the risk factors related to the onset of gallbladder cancer include gallstone, gallbladder polyps, primary sclerosing cholangitis, etc. In this review, we discuss the relevant latest research on the risk factors of the onset of gallbladder cancer in order to provide clinical evidence for the prevention and early diagnosis of gallbladder cancer. The intervention, follow-up, and monitoring of risk factors should be strengthened, and the possibility of malignancy of the gallbladder should be accurately assessed in combination with factors such as age and sex. In the case of possible malignancy, prophylactic cholecystectomy should be actively performed.