IDDF2019-ABS-0283 Laparoscopic-assisted transgastric ERCP in patients with gastric bypass: a single centre experience

Abstract

Background The management of patients who develop common bile duct calculi post gastric bypass is complicated as transoral access to the biliary tree is not possible. Majority of the patients may require a lap/open cbd exploration. We here describe our technique of accessing the cbd laparoscopically via the ampulla of vater. Methods Between January 2014 and January 2019 12 patients developed CBD calculi. 7 of them had undergone Roux en y gastric bypass (RYGB) and 5 of them had undergone mini gastric bypass (MGB). A combined laparoscopic-endoscopic approach was attempted. A small gastrotomy with a purse-string suture was performed on the anterior wall on remanant stomach. A side viewing scope was introduced through a 15 mm trocar on the upper left quadrant and through the gastrotomy. The duodenum was occluded to prevent air passage and small bowel distension. Endoscopic sphincterotomy and stone extraction were carried out according to standard techniques. Occlusion cholangiogram confirmed CBD clearance. There was no procedure-related complication, and the patients were discharged on the second postoperative day. The patient is doing well at 6-months follow up. Results The detection of CBD calculi was on an average after 3 years post gastric bypass. All patients were managed as per the described technique and the mean hospital stay was 3 days. Seven patients underwent simultaneous cholecystectomy. Two patients had cholecystectomy more than 2 years previously. Our technique involves access to the bypassed stomach via a laparoscopically placed 15 mm port. We observed no major complications. No minor complications except, port site infection for one patient was observed in our series. Conclusions The formation of gallstones post gastric bypass is a known entity and they can migrate into the CBD. Management of these presents a unique dilemma. LAERCP (Laproscopic ERCP) is a reliable option for common bile duct clearance; our technique of LAERCP is technically simple and associated with low complication rate, making it appealing to surgeons trained in laparoscopy.