Management of the Gallbladder Before and After Bariatric Surgery

Cholecystectomy is common following bariatric surgery procedures, making the assessment of gallbladder disease a critical component of post-bariatric surgery care. From the standpoint of patient education, there must be an emphasis on adherence to prophylactic therapy, should it be prescribed by the surgeon. For the bariatric surgeon, a conscientious decision must be made regarding the necessity and timing of a cholecystectomy. This chapter will describe the pathophysiology of cholesterol gallstone formation, specifically addressing the unique changes that occur after bariatric surgery; discuss the role of prophylactic cholecystectomy and other management strategies of gallbladder disease; and, finally, address the systems-based challenges in the work-up and management of biliary problems after bariatric surgery.