Benefsha Mohammad, MD1, Michele Richard, MD1, Steve Brandwein, MD2, Keith Zuccala, MD3. 1Danbury Hospital, 2Danbury Hospital Department of Gastroenterology, 3Danbury Hospital Department of Surgery
Introduction: Obesity is a prevalent issue in today’s society, which has increased the number of gastric weight loss surgeries. This presents an anatomical challenge to biliary disease requiring endoscopic retrograde cholangiopancreatography (ERCP). In gastric bypass patients, traditional ERCP via the mouth in these patients is technically more challenging, requiring a longer endoscope with a reported success rate of less than 70%. A solution is laparoscopic assisted ERCP (LA-ERCP) via gastrostomy. This minimally invasive technique has become increasingly more prevalent and safe. We present our experience with LA-ERCP at our teaching community hospital in a large cohort of patients.
Methods and Procedures: Retrospective chart review was performed on all patients with a history of prior laparoscopic gastric bypass surgery who underwent LA-ERCP from April 2008 to April 2016. The procedure was performed by two different general surgeons and one gastroenterologist. A pursestring suture and transfacial stay sutures were used to bring the gastric remnant to the abdominal wall. A gastrostomy was then created and accessed by the duodenoscope to perform the ERCP. Biliary sphincterotomy, papillary or biliary dilation, lithotripsy, stent placement, and/or stone removal were performed as indicated. We observed the incidence of postoperative outcomes, including acute pancreatitis, reoperation, post-procedure infection, pain control, hospital re-admission and bile leak.
Results: Thirty-two patients met inclusion criteria. Six patients were male and twenty-six were female, with mean ages of 59 (std dev 7) and 53 years (std dev 15), respectively. Indications for LA-ERCP included suspected choledocholithiasis (25/32), cholangitis with choledocholithiasis (2/32), acute pancreatitis (2/32), abdominal pain with abnormal LFT (1/32), cholangitis with cholecystitis (1/32), and bile leak (1/32). LA-ERCP was successfully performed in all thirty-two patients. Biliary cannulation, sphincterotomy and stone extraction were performed on 31/32 patients, and one patient underwent sphincterotomy and stent placement for bile leak after recent laparoscopic cholecystectomy. One patient developed acute pancreatitis with elevated pancreatic enzymes which resolved after conservative treatment. One patient required a second LA-ERCP for stent replacement due to a persistent bile leak. The median length of stay was 2 days (range 1-10 days).
Conclusions: LA-ERCP is a safe and feasible alternative to open surgery, and can be safely implemented at community hospitals with adequately trained providers. Obesity is a growing burden on society, increasing the incidence of weight loss surgery. Our large study proves that in this minimally invasive era, LA-ERCP provides gastric bypass patients a safe alternative with less pain and increased satisfaction.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86832
Program Number: P106
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster