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Obesity Surgery

, Volume 25, Issue 2, pp 373–376 | Cite as

Laparoscopy-Assisted Transgastric Endoscopic Retrograde Cholangiopancreatography (ERCP) After Roux-en-Y Gastric Bypass: Technical Features

  • Enrico FacchianoEmail author
  • Giovanni Quartararo
  • Vittorio Pavoni
  • Gadiel Liscia
  • Riccardo Naspetti
  • Alessandro Sturiale
  • Marcello Lucchese
How I Do It

Abstract

Background

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.

Methods

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.

Conclusion

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.

Keywords

Laparoscopy Obesity ERCP Gastric bypass Bariatric surgery Gallstones Biliary tract 

Notes

Statement of Informed Consent

Informed consent to perform the procedure herein described was obtained from the patient.

Statement of Human and Animal Rights—Ethical Approval

For this type of study, formal consent is not required.

Conflict of Interest

The authors declare that there are no conflicts of interest.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Enrico Facchiano
    • 1
    Email author
  • Giovanni Quartararo
    • 1
  • Vittorio Pavoni
    • 2
  • Gadiel Liscia
    • 1
  • Riccardo Naspetti
    • 3
  • Alessandro Sturiale
    • 1
  • Marcello Lucchese
    • 1
  1. 1.Department of Surgery, Bariatric and Metabolic Surgery UnitSanta Maria Nuova HospitalFlorenceItaly
  2. 2.Department of Anesthesiology, Anesthesia for Bariatric Surgery UnitSanta Maria Nuova HospitalFlorenceItaly
  3. 3.Surgical Endoscopy UnitCareggi University HospitalFlorenceItaly

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