Surgery

Biography

Biography: L. Renee Hilton

Abstract

Gallstone disease is one of the most prevalent disease processes being managed by general surgeons across the country; in some studies as high as 15% of the population will be diagnosed with cholelithiasis annually. Cholelithiasis is even more prevalent in the bariatric patient population due to rapid weight loss and is seen in 30-71% of patients. Both the increase in bariatric procedures being performed each year along with the change in practice at most institutions of no longer performing cholecystectomy at the time of initial surgery presents us with a new surgical problem; how should we manage bariatric patients who present with gallstone disease? Diagnosis of gallstone disease in bariatric patients can be a difficult challenge due to many possible etiologies of abdominal pain; however, like the general population, the most common presenting symptoms of gallstone disease are post-prandial right upper quadrant or epigastric abdominal pain and mild nausea with or without vomiting. Evaluation is similar to that of the general population and includes laboratory testing and multiple imaging modalities. Management of gallstone disease in post-operative bariatric patients largely depends on the type of surgery that they have had and whether their foregut anatomy is altered. The purpose of this paper is to review the current literature as well as our own experience to provide a standard for both diagnosing and managing gallstone disease in patients who have had bariatric surgery. Lastly, it is our opinion and recommendation that any patient with gallstone disease and altered foregut anatomy be managed at a tertiary center where a multidisciplinary team is available. The surgeon involved in the case should be an experienced laparoscopic surgeon in either hepatobiliary or bariatric surgery. These cases are technically challenging and adequate knowledge of the surgical foregut anatomy is required to surgically manage these patients safely.