Facchiano Enrico, Quartararo Giovanni, Pavoni Vittorio, Liscia Gadiel, Naspetti Riccardo, Sturiale Alessandro, Lucchese Marcello
Department of Surgery, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, P.zza S. Maria Nuova, 50122, Florence, Italy,
Obes Surg. 2015 Feb;25(2):373-6. doi: 10.1007/s11695-014-1516-3.
Laparoscopic gastric bypass is one of the most performed bariatric operations worldwide. The exclusion of stomach and duodenum after this operation makes the access to the biliary tree, in order to perform an endoscopic retrograde cholangiopancreatography (ERCP), very difficult. This procedure could be more often required than in overall population due to the increased incidence of gallstones after bariatric operations. Among the different techniques proposed to overcome this drawback, laparoscopic access to the excluded stomach has been described by many authors with a high rate of success reported.
We herein describe our technique to perform laparoscopic transgastric ERCP. A gastrotomy on the excluded stomach is performed to introduce a 15-mm trocar. Two stitches are passed through the abdominal wall and placed at the two sides of the gastrotomy for traction. The intragastric trocar is used to pass a side-viewing endoscope to access the biliary tree.
In patients with a past history of Roux-en-Y gastric bypass (RYGB), the present technique allows us a standardized, safe, and reproducible access to the major papilla and the biliary tree using a transgastric access. This will lead to simplify the procedure and reduce the risk of peritoneal contamination.
腹腔镜胃旁路手术是全球开展最为广泛的减肥手术之一。该手术后胃和十二指肠被排除在外，这使得在进行内镜逆行胰胆管造影术（ERCP）时，进入胆管树变得非常困难。由于减肥手术后胆结石发病率增加，该手术比普通人群更常需要进行ERCP。在为克服这一缺点而提出的不同技术中，许多作者描述了腹腔镜进入被排除胃的方法，并报告了很高的成功率。
我们在此描述我们进行腹腔镜经胃ERCP的技术。在被排除的胃上做一个胃切开术以插入一个15毫米的套管针。两根缝线穿过腹壁并置于胃切开术两侧用于牵引。胃内套管针用于插入侧视内镜以进入胆管树。
对于有Roux-en-Y胃旁路术（RYGB）既往史的患者，本技术使我们能够通过经胃途径标准化、安全且可重复地进入十二指肠乳头和胆管树。这将简化手术并降低腹腔污染风险。
