Bariatric Section, General Surgery Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD, Buenos Aires, Argentina.
HPB Section, General Surgery Department, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD, Buenos Aires, Argentina.
Surg Endosc. 2021 Dec;35(12):6913-6920. doi: 10.1007/s00464-020-08201-3. Epub 2021 Jan 4.
Treatment of choledocholithiasis after Roux-en-Y gastric bypass (RYGB) is a therapeutic challenge given the altered anatomy. To overcome this technical difficulty, different modified endoscopic approaches have been described but significant morbidity accompanies these procedures. The aim of the present study is to report our experience with laparoscopic transcystic common bile duct exploration (LTCBDE) as treatment of choledocholithiasis after RYGB.
This is a retrospective cohort study of 854 consecutive patients with RYGB at a single institution between January 2007 and December 2019. Our study population focused on patients who developed biliary events after RYGB. Demographic data and perioperative parameters were compared between patients who underwent laparoscopic cholecystectomy (LC) after RYGB with (defined as Group A) and without (defined as Group B) LTCBDE.
Fifty-seven (8.93%) patients developed a biliary event after RYGB that led to LC. Of those, 11 (19.2%) presented choledocholithiasis during intraoperative cholangiogram and were simultaneously treated with LTCBDE (Group A). Choledocholithiasis was unsuspected in the preoperative setting in 7 (63.6%) of the 11 patients. The procedure was successful in 90.9% (n = 10). Comparing Group A and B, no statistically significant differences were found regarding age, gender, length of hospital stay, and morbidity (p > 0.05). Mean operative time of Group A was 113.1 min, adding, on average, 35 min to LC (113.1 min vs 77.9 min, p = 0.004).
LTCBDE offers an effective approach for common bile duct stones in patients who underwent RYGB. This procedure did not add significant length of hospital stay nor morbidity to laparoscopic cholecystectomy.
由于 Roux-en-Y 胃旁路术（RYGB）后的解剖结构发生改变，治疗胆总管结石是一个治疗挑战。为了克服这一技术难题，已经描述了不同的改良内镜方法，但这些方法伴随着显著的发病率。本研究旨在报告我们使用腹腔镜经胆囊管胆总管探查术（LTCBDE）治疗 RYGB 后胆总管结石的经验。
这是一项回顾性队列研究，纳入了 2007 年 1 月至 2019 年 12 月期间在一家机构接受 RYGB 的 854 例连续患者。我们的研究人群集中在 RYGB 后发生胆道事件的患者。比较了在 RYGB 后行腹腔镜胆囊切除术（LC）的患者（定义为 A 组）和未行 LC 的患者（定义为 B 组）的人口统计学数据和围手术期参数。
57 例（8.93%）患者在 RYGB 后发生胆道事件，导致 LC。其中，11 例（19.2%）在术中胆管造影时发现胆总管结石，并同时行 LTCBDE 治疗（A 组）。在术前检查中，11 例患者中有 7 例（63.6%）未发现胆总管结石。90.9%（n=10）的患者手术成功。比较 A 组和 B 组，两组在年龄、性别、住院时间和发病率方面无统计学差异（p>0.05）。A 组的平均手术时间为 113.1 分钟，LC 平均增加 35 分钟（113.1 分钟比 77.9 分钟，p=0.004）。
LTCBDE 为 RYGB 后胆总管结石患者提供了一种有效的治疗方法。该手术并未增加腹腔镜胆囊切除术的住院时间和发病率。
