I have read only contradictory commentaries on this subject - should cholecystectomy (for confirmed gallstones, not routine prophylactic) and hiatal hernia repair be done along with gastric bypass or sleeve gastrectomy ?
It's better to leave the gallbladder for next 6 months after bariatric surgery.regarding haitus.if the operation is sleeve it's better to convert to mini gastric bypass and repair the hernia
It is better to do cholecystectomy at the same time ,I do agree some donot in asymtomatic stones.However Hiatal repair is necessary to prevent sleeve or gastric pouch migration. I assume pt has no Gerd.
Strictly no reason to remove asymptomatic gallbladder with stone during bariatric procedure,
on the contrary hiatal hernia repair is necessary
I repair hiatal hernia's when found. The gallbladder is complex and remains contriversial, In gastric bypass patients I remove the GB if there are stones and put on ursodial if no stones. I sleeve patients I only remove GB if patient is symptomatic.
Thanks very much everyone for your valuable input. It seems that hiatus hernia management is quite clear, but are there any established guidelines for gall bladder stone management ? I'm also asking for medicolegal purposes
By removing a symptomatic Gall Bladder with stones with prior informed consent will not be a problem.I feel that most of us practice rather than a second stage.It adds about 10 to 15 mts extra in your hands.
Dear M Rangarajan.
It depends on.
Asymptomatic gallstone disease could be managed with or without cholecystectomy during a bariatric procedure.
PROS: risk of gallstone complications dissapear when a significant loss of weight is coming.
AGAINST: lap cholecystectomy could add 30-40 min in an obese patient with a huge, fatty gall bladder. There are more risks of injuries and an extratime for the operation.
Many obese patients have a small HH with GER in barium sallow but some of them become symtomatic. I always study possible GERD, based upon medical history, with upper endoscopy, manometry and phmetry. If it is positive, I would offer a bypass, if not, a sleeve could be useful.
Thanks guys. I was just reading the International Bariatric Club recommendations regarding the hiatal hernia issue. They write:
"In the presence of a hiatal hernia, no effort is made to address this at the time of MGB. Experience has shown that MGB is very effective in resolving GERD. This is thought to be related to traction which the GJ anastomosis provides on the gastric pouch, which reduces the cardia within the abdomen"
This is the link:
http://www.ibcclub.org/mini-gastric-one-anastomosis-bypass-becoming-a-mainstream-bariatric-operation/
MGB/OAGB is different because of long gastric pouch and anti reflux suture.But for Sleeve and RNY GB, hiatal repair is advisable.
Lap chole is mandatory during bariatric procedure.
Dont do sleeve in hiatus hernia pt.
Do RYGB / OAGB ,crruroraphy if large histus nothing else .
If the pt has Gall stones,it is better to do cholecystectomy at the same time.For Hiatus hernia with out reflux reduce the hernia including the sac and do a cruroplasty.If the Hiatus is big and crura are weak ,use a prosthetic mesh to reenforce and do a Bypass RYGB/OAGB depending on other factors and your preference.
If gallstones, I would recommed cholecystectomy. If hiatal hernia is present, with GERD -> NO sleeve and MGB or RY by-pass, with the repair of the hiatus.
Recently, some of my bariatric patients with GERD/hiatus hernia insisted they wanted the sleeve and not bypass (for whatever reason) in spite of me explaining that bypass was better in this situation. So I did a hiatal hernia repair with sleeve for this small subset, and surprisingly found that they did have reasonable relief of reflux !! I wonder if anybody else had a similar experience in their practice ?
Takes very little time to reduce the hiatus hernia and repair the diaphragm as part of a RYGB. If the stones are symptomatic then cholecystectomy. If asymptomatic and anatomy is not being altered (ie sleeve) then tempting to not overcomplicate the bariatric operation and leave gb in situ. Argument for chokecystectomy with bypass mich stronget because of loss of ability to access the biliary tree if patiebt unlucky enough to deveop CBD stones
- Badges
- Science topic
- Similar topics
- Social Psychology
- Attitude