Section of Surgery, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden.
Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
Surg Obes Relat Dis. 2023 Aug;19(8):882-888. doi: 10.1016/j.soard.2023.01.023. Epub 2023 Feb 3.
Treatment of common bile duct (CBD) stones after Roux-en-Y gastric bypass (RYGB) poses a particular challenge given the altered anatomy and inability to perform a standard endoscopic retrograde cholangiogram (ERC). The optimal treatment strategy for intraoperatively encountered CBD stones in post-RYGB patients has not been established.
To compare outcomes following laparoscopic transcystic common bile duct exploration (LTCBDE) and laparoscopy-assisted transgastric ERC for CBDs during cholecystectomy in RYGB-operated patients.
Swedish nationwide multi-registry study.
The Swedish Registry for Gallstone Surgery and ERCs, GallRiks (n = 215,670), and the Scandinavian Obesity Surgery Registry (SOReg) (n = 60,479) were cross-matched for cholecystectomies with intraoperatively encountered CBD stones in patients with previous RYGB surgery between 2011 and 2020.
Registry cross-matching found 550 patients. Both LTCBDE (n = 132) and transgastric ERC (n = 145) were comparable in terms of low rates of intraoperative adverse events (1% versus 2%) and postoperative adverse events within 30 days (16% versus 18%). LTCBDE required significantly shorter operating time (P = .005) by on average 31 minutes, 95% confidence interval (CI) [10.3-52.6], and was more often used for smaller stones <4 mm in size (30% versus 17%, P = .010). However, transgastric ERC was more often used in acute surgery (78% versus 63%, P = .006) and for larger stones >8 mm in size (25% versus 8%, P < .001).
LTCBDE and transgastric ERC have similarly low complication rates for clearance of intraoperatively encountered CBD stones in RYGB-operated patients, but LTCBDE is faster while transgastric ERC is more often used in conjunction with larger bile duct stones.
由于解剖结构改变以及无法进行标准的内镜逆行胰胆管造影（ERC），Roux-en-Y 胃旁路术（RYGB）后治疗胆总管（CBD）结石具有一定的挑战性。对于 RYGB 术后患者术中发现的 CBD 结石，尚未确定最佳的治疗策略。
比较腹腔镜经胆囊管胆总管探查术（LTCBDE）和腹腔镜辅助经胃 ERC 治疗 RYGB 术后胆囊切除术中 CBD 结石的疗效。
瑞典全国多登记处研究。
2011 年至 2020 年，对瑞典胆囊结石手术和 ERC 登记处（GallRiks，n = 215670）和斯堪的纳维亚肥胖手术登记处（SOReg，n = 60479）进行交叉匹配，以确定 RYGB 术后患者在胆囊切除术中发现 CBD 结石。
登记处交叉匹配发现 550 例患者。LTCBDE（n = 132）和经胃 ERC（n = 145）在术中不良事件发生率（1%对 2%）和术后 30 天内不良事件发生率（16%对 18%）方面均无显著差异。LTCBDE 手术时间明显缩短（P =.005），平均缩短 31 分钟，95%置信区间（CI）[10.3-52.6]，且常用于直径<4 mm 的较小结石（30%对 17%，P =.010）。然而，经胃 ERC 更常用于急性手术（78%对 63%，P =.006）和直径>8 mm 的较大结石（25%对 8%，P <.001）。
LTCBDE 和经胃 ERC 治疗 RYGB 术后患者术中发现的 CBD 结石的并发症发生率相似，但 LTCBDE 速度更快，而经胃 ERC 更常用于较大的胆管结石。
