Management of biliary symptoms after bariatric surgery

Brockmeyer, Joel R.; Grover, Brandon T.; Kallies, Kara J.; Kothari, Shanu N.

doi:10.1016/j.amjsurg.2015.07.003

Cited by 33 publications

(20 citation statements)

References 23 publications

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“…Impacted stones may be difficult to be extracted through ERC rather than through a cholangiotomy. Furthermore, LCBDE and transcystic stone extraction can be performed in patients with a Roux-en-Y shunt ( 10 ). With the increasing numbers of patients undergoing obesity surgery, this has become an increasing challenge ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Common Bile Duct Exploration: 9 Years Experience from a Single Center

2016

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IntroductionThe aim of the study was to evaluate the safety and feasibility of laparoscopic common bile duct exploration (LCBDE) through cholangiotomy with T-tube placement in one séance for common bile duct stones (CBDS).MethodsBetween January 2005 and December 2010, a total of 99 patients with CBDS stones undergoing LCBDE with T-tube insertion at Enköping Hospital, Sweden, were registered prospectively. All patients were followed up by review of the patient records according to a standardized protocol.ResultsNo severe intraoperative complications were registered. Four procedures required conversion to open cholecystectomy due to impacted stones or technical difficulty. The mean operative time was 194 min [(SD) 57 min]. The mean postoperative hospital stay was 4.8 days, SD 2.4 days. At secondary cholangiography, 2 (2%) retained stones were found. Two (2%) patients had minor bile leakage, which resolved spontaneously. None of the patients experienced biliary peritonitis, biliary fistula, pancreatitis, or cholangitis. No death within 30 days after surgery was seen. No patient was readmitted with clinical signs of stricture.ConclusionIf performed by a surgeon familiar with the technique, LCBDE is a safe and feasible alternative for managing CBDS. The advantages are most pronounced in the case of multiple and large CBDS. The risk for retained stones and stricture is low.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Common Bile Duct Exploration: 9 Years Experience from a Single Center

2016

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“…Bariatric surgery is the most effective method for sustained weight loss for obese patients who fail conventional lifestyle intervention therapy [2,3]. Roux-en-Y gastric bypass (RYGB) has been one of the most commonly performed bariatric procedures [4].…”

Section: Introductionmentioning

confidence: 99%

“…Patients with a body mass index (BMI) of more than 40 kg/m 2 have an eight-fold increased risk of cholelithiasis compared with patients with a lower BMI [4]. The risk for cholelithiasis is further increased after RYGB, which may be due to increased bile cholesterol saturation during rapid weight loss and gallbladder hypomotility owing to the duodenal bypass [4 -6].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass

et al. 2020

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Background Patients who have undergone Roux-en-Y gastric bypass (RYGB) are at increased risk of biliary disease necessitating endoscopic retrograde cholangiopancreatography (ERCP). The most widely used approaches to perform ERCP after RYGB are laparoscopy-assisted ERCP (LA-ERCP) and balloon enteroscopy-assisted ERCP (BEA-ERCP). There are few studies comparing these procedures. We aimed to compare the performance, benefits, and harms of LA-ERCP and BEA-ERCP in RYGB patients. Methods We identified all RYGB patients who underwent ERCP at two tertiary care endoscopy centers in Oslo, Norway between May 2013 and December 2017. One center performed BEA-ERCP, the other LA-ERCP. Procedure success was defined as fulfillment of the therapeutic or diagnostic aim, according to the procedure description. Adverse events were classified according to the Clavien–Dindo grading system. Results During the study period, 40 BEA-ERCP and 39 LA-ERCP procedures were performed in 68 patients. Procedure success rate was 72.5 % for BEA-ERCP and 87.2 % for LA-ERCP (P = 0.14). Adverse events occurred in 18 % of BEA-ERCP and 28 % of LA-ERCP (P = 0.23). Serious adverse events (Clavien–Dindo grade ≥ 3b) occurred in 2.5 % of BEA-ERCP and 7.7 % of LA-ERCP procedures (P = 0.36). Concomitant cholecystectomy was performed in 25 of the 39 LA-ERCP procedures. The median procedure times for LA-ERCP performed with and without concomitant cholecystectomy were 201 minutes and 140 minutes, respectively, and for BEA-ERCP was 125 minutes. Conclusions In experienced hands, both LA-ERCP and BEA-ERCP have high success rates after RYGB. The choice of approach should be individualized according to patient characteristics and available physician competence.

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“…When directly comparing metabolic surgery procedures, the same analysis revealed that those who underwent LSG had 2.3 times higher odds of developing AP compared with those who underwent Roux‐en‐Y gastric bypass (RYGB) . On analyzing our single‐center experience, we found that AP was the prominent postoperative complication of LSG in our child and adolescent population rather than the BC and cholecystitis symptoms reported in adults . In the Teen‐Longitudinal Assessment of Bariatric Surgery (Teen‐LABS) study, investigators reported an incidence of AP of 0.6% occurring in their patients who underwent RYGB and no incidence in their patients who underwent LSG 3 years after initial surgery .…”

Section: Discussionmentioning

confidence: 83%

“…Overall, LSG remains a safe and effective surgical weight loss option in children and adolescents despite the findings of AP and BC in our cohort. Prior reports in the adult metabolic surgery population have shown that symptomatic cholelithiasis occurs at a rate of 8% and that AP occurs at a rate of 0.21% to 1.04% . When comparing the 6‐month interval between the pre‐ and postprocedure periods, Hussan et al demonstrated that adults who underwent LSG had high odds (5.2 times greater) of developing AP.…”

Section: Discussionmentioning

confidence: 99%

Pattern of Biliary Disease Following Laparoscopic Sleeve Gastrectomy in Adolescents

Tashiro

Thenappan

Nadler

2019

Obesity

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Objective The use of laparoscopic sleeve gastrectomy (LSG) has risen steadily as a treatment for adolescents with obesity. This study determined whether obstructive biliary complications after rapid, LSG‐related weight loss occur similarly in adolescents compared with adults. Methods Between 2010 and 2019, 309 patients underwent LSG. Demographics and clinical factors, including pre‐ and perioperative BMI and weight changes, were included. Results Overall, 21 patients (7%) had post‐LSG biliary disease (BD), of whom 13 presented with acute pancreatitis (AP) and 8 with biliary colic. No differences existed between those with BD (n = 21) and the remaining cohort (n = 288). Patients with BD were 16.3 (SD 2.4) years of age at LSG, with a preoperative BMI of 49.3 (SD 6.7) kg/m2. Preoperative excess BMI loss was 7.1% (SD 11.3%). An ultrasound revealed gallstones (71%) and sludge or crystals (12%). Eighteen patients underwent cholecystectomy between 4 weeks and 29 months after LSG. Conclusions Pediatric patients present with BD at a similar rate after LSG compared with adults. The majority of adolescents, however, manifest with AP. Thus, pancreatitis should be high on the differential diagnosis list when evaluating post‐LSG abdominal symptoms. Additional studies are warranted to elucidate the pathophysiology of post‐LSG AP for prevention in the future because its etiology may or may not be solely related to BD.

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Management of biliary symptoms after bariatric surgery

Cited by 33 publications

References 23 publications

Laparoscopic Common Bile Duct Exploration: 9 Years Experience from a Single Center

Laparoscopic Common Bile Duct Exploration: 9 Years Experience from a Single Center

Laparoscopy-assisted versus balloon enteroscopy-assisted ERCP after Roux-en-Y gastric bypass

Pattern of Biliary Disease Following Laparoscopic Sleeve Gastrectomy in Adolescents

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