Laparoscopic-assisted transgastric endoscopic retrograde cholangiopancreatography for management of choledocolithiasis after mini-gastric bypass surgery

Abstract

Background Gallstones commonly form after bariatric surgery owing to rapid weight loss. Choledocolithiasis is one of the dangerous sequelae of gallstones. Mini-gastric bypass (MGBP) excludes the biliary tree from traditional evaluation and treatment with endoscopic retrograde cholangiopancreatography (ERCP). This prevents ERCP to be done through the normal route. Objective To assess the feasibility and outcome of laparoscopic-assisted transgastric ERCP in patients with choledocolithiasis after MGBP for extraction of common bile duct (CBD) stones. Patients and methods A retrospective study was conducted on 15 patients who had gallstones discovered in the CBD after MGBP in five bariatric centers. Overall, 750 participants (BMI >35 kg/m2) were observed after undergoing MGBP over 2 years, and 10 of them were included in the study after being diagnosed with primary CBD stones and presented with jaundice during a period of 2 years after surgery. All patients were hospitalized, and gallstones were extracted laparoscopically through a transgastric approach except for two patients. Results Of 15 patients, 11were managed laparoscopically, and gallstones were extracted successfully. Four patients were converted to open surgery, but the scope was still used in three of them to extract the stones, and the last one underwent open CBD exploration. Conclusion Laparoscopic-assisted transgastric ERCP is an effective and safe way of management of choledocholithiasis in post-MGBP patients.