Biliopancreatic access following anatomy-altering bariatric surgery: a literature review

Papasavas, Pavlos; Docimo, Salvatore; Oviedo, Rodolfo J.; Eisenberg, Dan

doi:10.1016/j.soard.2021.09.011

Cited by 6 publications

(13 citation statements)

References 75 publications

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“…TGERCP provides the advantage of using a standing side-viewing duodenoscope, however, the angle of the papilla may be altered considering the patient is in a supine position. Also, if clinically indicated, a gastrostomy tube can be left in place for future access to the pancreaticobiliary system 23. Disadvantages of a Transgastric endoscopic retrograde cholangiopancreatography include wound site infections (15% of cases), an overall adverse event rate of 20%, and an average operating room time of 2.5 hours 24.…”

Section: Discussionmentioning

confidence: 99%

“…Also, if clinically indicated, a gastrostomy tube can be left in place for future access to the pancreaticobiliary system. 23 Disadvantages of a Transgastric endoscopic retrograde cholangiopancreatography include wound site infections (15% of cases), an overall adverse event rate of 20%, and an average operating room time of 2.5 hours. 24 An additional drawback of TGERCP is the difficulty associated with coordinating both a surgical and gastroenterology teams.…”

Section: Discussionmentioning

confidence: 99%

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Transcystic Choledochoscopy Utilizing a Disposable Choledochoscope: How We Do It

Campbell

Pryor

Docimo

2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Biliary disease is common occurrence and can make up a large portion of the practice of a general surgeon. Choledocholithasis is a common entity amongst those with biliary disease. Although modern trends favor endoscopic retrograde cholangiopancreatography (ERCP) and other imaging modalities for the diagnosis and management of choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) is likely underutilized.Methods: A literature summary utilizing a PUBMED search was performed to provide an up-to-date account regarding the latest data on LCBDE. A video identifying and explaining the critical components of a LBCDE procedure is provided.Results: LCBDE is an underutilized procedure which offers equivalent clinical outcomes compared with ERCP along with a shorter length of stay and reduced costs. LCBDE is also noted to be an effective option for common bile duct stones in the setting of altered anatomy, such as a Roux-en-Y gastric bypass. Conclusion:Although modern trends favor ERCP and other imaging modalities for the diagnosis and management of choledocholithiasis, LCBDE is likely underutilized by surgeons. LCBDE can provide many benefits to patients including avoidance of additional procedures, shorter length of stay, higher success rates, and less costs. Out video should act is a guide for those surgeons interested in implementation LCBDE in their practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transcystic Choledochoscopy Utilizing a Disposable Choledochoscope: How We Do It

Campbell

Pryor

Docimo

2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Then, the tube is removed, and the tract is dilated with a balloon to an extent that will allow the passage of the duodenoscope. After completion of the dilation of the tract, ERCP can be repeatedly performed[ 7 ]. Given the wide availability of gastrostomy tubes, we believe that the abovementioned technique has particular value for the clinicians involved in the management of bariatric patients and should be supplemented in this review.…”

Section: To the Editormentioning

confidence: 99%

Reconstructing the puzzle of the role of therapeutic endoscopy in the management of post-bariatric surgery complications

Argyriou¹,

Parra‐Blanco²

2022

WJG

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We have recently read with interest the mini-review article "Therapeutic endoscopy for the treatment of post-bariatric surgery complications". The abovementioned article is a brief overview of the different endoscopic modalities employed in the management of bariatric surgery complications and represents an important decision support tool for clinicians to improve their current practice. Although we appreciate the endeavor of Larsen and Kozarek, based on our in-depth analysis, we came across several minor issues in this article; thus, we present our comments in this letter. In case the authors contemplate these comments in their relevant research, we believe that their contribution would be considerable for future studies.

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“…[3][4][5][6] The rate of patients who develop cholelithiasis following bariatric surgery is around 30% 3,7 and roughly 10% of these patients will develop symptomatic gallbladder disease. [3][4][5] Patients who undergo bariatric surgery are at a higher risk of developing gallstones due to a variety of factors including changes in metabolism, leading to higher levels of cholesterol in bile, slower rates of gallbladder emptying, and an increase of mucin in the bile following bariatric surgery. 5 Roughly 5% to 15% of patients undergoing cholecystectomy will have choledocholithiasis.…”

mentioning

confidence: 99%

“…8 When a patient develops choledocholithiasis, surgical interventions utilize endoscopic retrograde cholangiopancreatography (ERCP) to virtualize the biliary tract to remove the obstruction. 3 Patients who have had bariatric surgery face an anatomic obstacle to performing an ERCP. The proximal anatomy is altered in patients with a Roux-En-Y gastric bypass, which increases the length of the small bowel that must be traversed to access the ampulla of Vader with ERCP.…”

mentioning

confidence: 99%

How I Do It: Robotic Choledochoscopy

Acho,

Calzon,

Docimo

2024

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: As the use of the robotic platform increases among general surgeons, the amount of robotic cholecystectomies is expected to increase as well. The use of intraoperative cholangiography is valuable in assessing for choledocholithiasis. We describe our technique of performing robotic intraoperative cholangiograms with choledochoscopy. Out technique aids in efficiency since no undocking is required. Methods: Preoperatively, the decision to perform a cholangiogram is made based on physical exam, labs, and imaging findings. The procedure begins with obtaining a critical view of safety. The robotic arms are positioned in a manner that allows all 4 robotic arms to remain docked. A ductotomy is made and the cholangiocatheter is introduced. The cholangiogram images are then interpreted and if a stone is seen in the common bile duct we will then perform a transcystic common bile duct exploration using the SpyGlass Discover digital. A complete cholangiogram is then performed. The cystic duct is secured and the gallbladder is removed from the liver bed. The patients are watched overnight and discharged on postoperative day 1. Conclusions: A robotic approach to performing a transcystic common bile duct exploration is a safe and reproducible treatment method for choledocholithiasis. Our approach offers an advantage since no undocking is required.

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Biliopancreatic access following anatomy-altering bariatric surgery: a literature review

Cited by 6 publications

References 75 publications

Transcystic Choledochoscopy Utilizing a Disposable Choledochoscope: How We Do It

Transcystic Choledochoscopy Utilizing a Disposable Choledochoscope: How We Do It

Reconstructing the puzzle of the role of therapeutic endoscopy in the management of post-bariatric surgery complications

How I Do It: Robotic Choledochoscopy

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