Objectives: To evaluate feasibility, safety and surgical outcome of laparoscopicallyassisted
endoscopic retrograde cholangiopancreatography (ERCP) through gastrotomy
in patients had Roux-en Y gastric bypass (RYGB) as a bariatric procedure and
indicated for ERCP.
Patients & Methods: The study included 12 patients had RYGB surgery since 1-4
years and developed biliary obstruction since 23.3±7 (13-36) days. Operative
procedure entails laparoscopic creation of gastrotomy, a sterile ERCP scope was
inserted through 12-mm port site and passed manually under laparoscopic
visualization through the gastrotomy orifice, and then sphincterotomy (papillotomy)
and cannulation were performed. Pre and post-procedural dye injection was
performed to assure biliary passages patency. Gastrotomy site was closed in two
layers.
Results: Laparoscopic exploration was performed successfully in all patients with
successful adhesiolysis in three patients. All patients had successful laparoscopic
creation of gastrotomy in gastric remnant uneventfully, but gastrotomy site bleeding
occurred in two cases and was controlled. All patients had successful sphincterotomy,
but cannulation and injection of dye for intraoperative choledochography was
successfully conducted in 10 patients (83.3%). Two patients required sphincter
stenting. Mean operative time was 66.9-110.5; range: 55-90 min; mean time till 1st
ambulation and oral intake was 1.6 and 11.5 hours, respectively and mean duration of
postoperative (PO) hospital stay was 32.9 hours. Eight minor postoperative
complications were encountered.
Conclusion: Laparoscopic trans-gastrotomy ERCP is feasible and safe for diagnosis
and treatment of biliary complications secondary to bariatric surgery with minimal
treatable complications |
