DuCoin Christopher, Moon Rena C, Teixeira Andre F, Jawad Muhammad A
Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
Department of Bariatric Surgery, Orlando Regional Medical Center & Bariatric and Laparoscopy Center, Orlando Health, Orlando, Florida.
Surg Obes Relat Dis. 2014 Jul-Aug;10(4):647-52. doi: 10.1016/j.soard.2014.01.027. Epub 2014 Jan 29.
After Roux-en-Y gastric bypass (RYGB), the new gastrointestinal configuration does not permit easy endoscopic access to the biliary system in the standard fashion. Common bile duct (CBD) stones have proved to be a challenge for both the surgeon and the endoscopist in this setting. We shall review our experience with laparoscopic choledochoduodenostomy as a treatment of choledocholithiasis after gastric bypass.
Between January 2000 and July 2012, 3115 patients underwent RYGB at our institution. Patients were included if they had postoperative CBD stones regardless of previous cholecystectomy. Treatment modality was laparoscopic choledochoduodenostomy. A retrospective chart review of a prospectively collected data was completed, noting the outcomes and complications of the procedure.
Of 3115 patients, 11 patients were included in this study. There were 8 female and 3 male patients with a mean age of 50.5 ± 10.9 (range, 34-66) years. The average time between primary RYGB and choledochoduodenostomy was 39.7 ± 33.8 (range 8-113) months. The average body mass index at primary surgery was 48.2 ± 8.1 (range 38.4-67.4) kg/m(2) and at choledochoduodenostomy was 29.5 ± 6.8 (range 22.7-46.9) kg/m(2). One patient had bile leak that was managed with drain. All patients had resolution of symptoms at a mean follow-up of 24.8 ± 26.9 (range 2-84) months.
This small case series suggests that, in experienced hands, laparoscopic choledochoduodenostomy is an option for safe and effective treatment of choledocholithiasis after gastric bypass.
在Roux-en-Y胃旁路术（RYGB）后，新的胃肠道结构不允许以标准方式轻松地通过内镜进入胆道系统。在这种情况下，胆总管（CBD）结石已被证明对外科医生和内镜医生都是一项挑战。我们将回顾我们应用腹腔镜胆总管十二指肠吻合术治疗胃旁路术后胆总管结石的经验。
2000年1月至2012年7月期间，我院有3115例患者接受了RYGB手术。如果患者术后有CBD结石，无论之前是否行胆囊切除术，均纳入研究。治疗方式为腹腔镜胆总管十二指肠吻合术。对前瞻性收集的数据进行回顾性图表分析，记录该手术的结果和并发症。
3115例患者中，11例纳入本研究。其中女性8例，男性3例，平均年龄50.5±10.9（范围34 - 66）岁。初次RYGB与胆总管十二指肠吻合术之间的平均时间为39.7±33.8（范围8 - 113）个月。初次手术时的平均体重指数为48.2±8.1（范围38.4 - 67.4）kg/m²，胆总管十二指肠吻合术时为29.5±6.8（范围22.7 - 46.9）kg/m²。1例患者出现胆漏，通过引流处理。所有患者在平均24.8±26.9（范围2 - 84）个月的随访中症状均得到缓解。
这个小病例系列表明，在经验丰富的医生手中，腹腔镜胆总管十二指肠吻合术是胃旁路术后安全有效地治疗胆总管结石的一种选择。
