GallBladder removal-easier than band?

[DrHekier 0]

One of my patients last week asked about gallbladder removal during her upcoming Lap Band so I offer some thoughts:

Many people who have not had weight loss surgery end up with stones in their gallbladder, but not all of those stones are symptomatic and cause pain. Since rapid weight loss or weight gain can cause the formation of gallstones it is an area of interest to bariatric physicians and patients.

There is a debate among physicians as to whether or not to perform a gallbladder removal at the time of weight-loss surgery. I recall that it was a topic of discussion at the American Society of Bariatric Surgery meeting I attended a couple of years ago, and there was no consensus as to whether or not remove the gallbladder. Some laparoscopic gastric bypass surgeons commented that the placement of the instruments for the bypass is not ideal for removal of the gallbladder, and hence that makes the surgery more difficult or makes it necessary to place more ports for instruments into the patient.

I am not aware of many Lap Band surgeons that remove the gallbladder at the time of surgery for the following reasons:

1) By removing the gallbladder you introduce the possibility of having bacteria enter the bloodstream or abdominal cavity, since the bile in the gallbladder can harbor bacteria. You would prefer not to do this in the presence of a foreign body, the Lap Band.

2) The port placement for the Lap Band may not be ideal for removing the gallbladder and more ports may need to be added.

3) It is felt by some that the more gradual weight loss seen with the Lap Band compared to gastric bypass makes the likelihood of developing gallstones lower.

4) While generally a safe surgery, gallbladder removal (cholecystectomy) does entail its own specific risks that are unique to that surgery, therefore adding a cholecystectomy to the Lap Band, theoretically adds to the risk of surgery.

To answer Amy's original question about the recovery from the surgery:

The laparoscopic cholecystectomy is generally well tolerated and most patients return to regular activity within a few days. I remember a patient who was a high school football couch and went to run practice the afternoon after his cholecystectomy. As with any surgery, everyone has a unique recovery based upon how their body responds to the surgery. Good luck!

[JulyBandster 1]

Thanks for your comments, Dr. Hekier - I'm anxious to have this done with...I'm eating a bland diet and hoping for no attacks between now and then. Thanks again!

AmyK