Brockmeyer Joel R, Grover Brandon T, Kallies Kara J, Kothari Shanu N
Minimally Invasive Bariatric Surgery and Advanced Laparoscopy Fellowship, Department of Medical Education, Gundersen Medical Foundation, La Crosse, WI, USA.
Department of General and Vascular Surgery, Gundersen Health System, 1900 South Avenue, C05-001, La Crosse, WI 54601, USA.
Am J Surg. 2015 Dec;210(6):1010-6; discussion 1016-7. doi: 10.1016/j.amjsurg.2015.07.003. Epub 2015 Sep 11.
Biliary disease requiring intervention can be complicated in the postbariatric surgery patient.
A retrospective review was completed to identify patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy from September 2001 to September 2014, and those who underwent biliary intervention were identified.
A total of 1527 patients underwent bariatric surgery during the study period. Of the 1,112 patients without prior cholecystectomy, 91 (8%) had biliary symptoms requiring intervention. Ninety patients underwent cholecystectomy, with 86 successfully completed laparoscopically. Six patients required laparoscopy-assisted percutaneous transgastric endoscopic retrograde cholangiopancreatography along with cholecystectomy to clear gallstones from the common bile duct. Three patients who had undergone cholecystectomy before bariatric surgery developed primary common bile duct stones.
Surgery for biliary disease after bariatric surgery can be completed successfully with minimal complications, and percutaneous transgastric endoscopic retrograde cholangiopancreatography has a high success rate of access to and clearance of the biliary tree.
需要干预的胆道疾病在减重手术后的患者中可能会很复杂。
完成一项回顾性研究，以确定2001年9月至2014年9月期间接受腹腔镜Roux-en-Y胃旁路手术或腹腔镜袖状胃切除术的患者，并确定那些接受胆道干预的患者。
在研究期间，共有1527例患者接受了减重手术。在1112例未行过胆囊切除术的患者中，91例（8%）有需要干预的胆道症状。90例患者接受了胆囊切除术，其中86例成功通过腹腔镜完成。6例患者需要腹腔镜辅助经胃内镜逆行胰胆管造影术联合胆囊切除术以清除胆总管结石。3例在减重手术前行胆囊切除术的患者发生原发性胆总管结石。
减重手术后的胆道疾病手术可以成功完成，并发症最少，经胃内镜逆行胰胆管造影术进入和清除胆道树的成功率很高。
