Division of Bariatric Surgery, AZ St-Blasius, Kroonveldlaan 50, 9200, Dendermonde, Belgium.
Obes Surg. 2009 Jun;19(6):806-8. doi: 10.1007/s11695-009-9829-3. Epub 2009 Mar 20.
The essential growth of the number of Roux-en-Y gastric bypass procedures will obviously be accompanied by an increase of cases of common bile duct lithiasis. It seems evident that a close cooperation between surgeon and endoscopist will be needed on a routine basis. A laparoscopic-assisted transgastric ERCP is a well-documented approach to investigate the pancreatico-biliary tree in patients where the duodenum has been bypassed as in Roux-en-Y gastric bypass. In this case we present the possibility of assisting the endoscopist not only by providing access to the gastric remnant but also by helping with laparoscopic instruments during duodenoscopy. A formally obese woman who had benefited from a RYGB developed recurrent jaundice despite a precedent common bile duct exploration and choledocho-duodenostomy. A laparoscopic-assisted transgastric endoscopy revealed an obstructed choledocho-duodenostomy caused by accretions around a migrated clip. The obstructing clip could be extracted by laparoscopic instruments under endoscopic control.
Roux-en-Y 胃旁路手术数量的显著增长显然伴随着胆总管结石病例的增加。显然，外科医生和内镜医生需要常规密切合作。腹腔镜辅助经胃内镜逆行胰胆管造影术是一种已被充分证明的方法，可用于研究已被旁路的十二指肠中的胰胆管树，如 Roux-en-Y 胃旁路手术。在这种情况下，我们提出了不仅通过提供进入残胃的通道，还通过在十二指肠镜检查期间帮助使用腹腔镜器械来协助内镜医生的可能性。一位接受过 RYGB 手术的肥胖女性尽管先前已经进行了胆总管探查和胆肠吻合术，但仍出现复发性黄疸。腹腔镜辅助经胃内镜检查显示，先前移位的夹导致吻合口堵塞。在内镜控制下，使用腹腔镜器械可以取出堵塞的夹子。
