Laparoscopically Assisted ERCP in a Case of Acute Cholangitis in a Patient with Biliopancreatic Diversion with Distal Gastric Preservation

Abstract

Roux-en-Y gastric bypass, biliopancreatic diversion (BPD; Scopinaro's technique), and BPD with distal gastric preservation (BPDGP) are different surgical procedures, currently performed with laparoscopic assistance, successfully used as a treatment for morbid obesity. All of these modalities bear the burden of a difficult access when it comes to explore and work within the biliary tract. We present a case of acute cholangitis due to choledocholithiasis in a patient with BPDGP for morbid obesity successfully managed by laparoscopy-assisted endoscopic retrograde cholangiopancreatography through the gastric remnant.

A Hybrid Endo-Laparoscopic Therapy for Common Bile Duct Stenosis of a Choledocho-Duodenostomy After a Roux-en-Y Gastric Bypass

“…On the other hand, when a therapeutic ERCP or gastroduodenoscopy is necessary, a transgastric endoscopic approach is a valid alternative for retrograde endoscopy. The feasibility and safety to perform ERCP via a laparoscopically assisted transgastric approach has been repeatedly demonstrated [7][8][9][10][11].…”

“…Several strategies have been developed to palliate the difficult access to the biliary tree [2][3][4][5][6][7][8][9][10][11][12]. One of the most common techniques is the laparoscopically assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP) [7][8][9][10][11].…”

“…One of the most common techniques is the laparoscopically assisted transgastric endoscopic retrograde cholangiopancreatography (ERCP) [7][8][9][10][11].…”

Detection and management of bile duct stones

“…Thus, surgical gastrostomy allows pancreatobiliary and duodenal access to treat BDSs and cholangitis. [80][81][82] An anticipated "difficult stone" (Ͼ15 mm) can be managed by mechanical lithotripsy, a method aimed at fragmenting the stones into small pieces. 83 This technique uses a mechanical lithotripter that consists of a stronger basket with a spiral sheath, against which the stone is crushed by applying regular force (Fig.…”

Effect of bariatric surgery on future general surgical procedures

“…[11] Entry into the distal stomach remnant can be achieved by either a trocar (15 mm) gastrostomy or by using ultrasonic shears. [11–13] The stomach is then held into the abdominal wall by either suturing it to the fascia or lowering the pneumoperitoneum (7 – 8 mm) or by configuring a tobacco pouch, to avoid leakage of the gastric contents. After introducing the endoscope through the 15 mm trocar, the endoscopist takes over, to carry out endoscopic retrograde cholangiopancreatography and retrieve the stones.…”