Intragastric single-port surgery (IGS) accesses the gastric remnant and allows ERCP for common bile duct stones after RYGB: a simple solution for a difficult problem
Pilot clinical study
A 70 year old female presented to our institution for evaluation and treatment of distal bile duct obstruction in the setting of prior duodenal switch for medically complicated obesity. The patient underwent placement of an internal/external biliary drain at an outside institution after presenting with abnormal liver tests, RUQ pain, and cross sectional imaging demonstrating a distal bile duct obstruction. She then underwent antegrade cholangioscopy with biopsy of the distal bile duct through the percutaneous access site.
The aim of the study was to assess the incidence of post ERCP bacteremia and evaluate in-hospital mortality and length of stay.
The objective of this study was to compare the preoperative serum levels of DPP-4 in patients with and without surgical finding of perivesicular inflammation. Materials and methods: a cross-sectional analytical study nested in a prospective cohort, including patients scheduled for elective cholecystectomy, without surgical complications, that were 18-70 years of age, with low cardiovascular risk, without a history of peritonitis, pancreatitis, or jaundice and underwent ERCP protocol, type 2 diabetes mellitus, acute inflammatory (Protein C Reactive
ConclusionTransjejunal LAERCP is a feasible technique to deal with choledocholithiasis, and it allows at the same time to identify and treat concomitant conditions like internal hernias.
ConclusionsLAERCP is a safe and successful procedure for the treatment of common bile duct lithiasis when conventional biliary access is not feasible, notably after RYGB. Larger trials still need to be performed to evaluate efficacy, technical success, and complications related to this technique.
Management of Sphincter of Oddi Dysfunction (SOD) requires advanced techniques (endoscopic retrograde cholangiopancreatography via gastrostomy [GERCP]) after Roux-en-Y gastric bypass (RYGB) for obesity. Transduodenal sphincteroplasty (TS) is also performed yet carries the risks of surgery. We hypothesized that TS would have increased morbidity and mortality but provide a more durable remission of symptoms.
AbstractHigh body mass index (BMI) is associated with other multiple comorbidities such as non-alcoholic fatty liver disease, steatohepatitis, liver cirrhosis, and cardiopulmonary diseases, which can impact the perioperative outcomes following liver resection. We aimed to study the impact of BMI on perioperative outcomes after robotic liver resection. All the patients undergoing robotic liver resection between 2013 and 2017 were prospectively followed. The patients were divided into three groups (BMI 35 kg/m2) for illustrative purposes. Demographic and perioperative outcome data were compared. Data ar...
ConclusionsLTG-ERCP is a safe and feasible alternative for gallstone cholangitis management in patients with RYGB. This procedure should be recommended for cases of cholangitis rather than laparoscopic choledocoscopy or a percutaneous transhepatic approach, especially in cases of prior cholecystectomy, or in patients where the BMI remains high. LTG-ERCP should be performed in a referral center by a skilled endoscopist and surgeon following a standardized technique.
AbstractAlthough balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography (BAE-ERCP) is a well-described means of accessing the duodenal papilla in patients with Roux-en-Y gastric bypass (RYGB), it is associated with modest clinical success rates. Laparoscopy-assisted ERCP (LA-ERCP) —performed by advancing a standard duodenoscope through a gastrostomy into the excluded stomach and duodenum—has emerged as a viable alternative to BAE-ERCP, with apparently higher success rates. In this systematic review, we compare LA-ERCP with enteroscopy-based techniques in post-RYGB patient s, including 22 ca...