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Laparoscopy-assisted ERCP after biliopancreatic diversion.
Massimiliano Mutignani1, Michele Marchese, Andrea Tringali
1Digestive Endoscopy Unit, Catholic University, Rome, Italy.
Obesity Surgery
|May 5, 2007
Summary
Therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is challenging after biliopancreatic diversion (BPD). This study reports a novel laparoscopy-assisted ERCP approach for accessing the bile duct in a patient with morbid obesity and prior BPD surgery.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Bariatric Surgery
Background:
- Therapeutic biliary endoscopy is often impossible after biliopancreatic diversion (BPD) due to altered anatomy.
- Previous methods for accessing the papilla include surgical gastrostomy or jejunostomy.
Observation:
- A case report details a laparoscopy-assisted ERCP performed 4 years after laparoscopic BPD with distal gastrectomy.
- Access to the papilla was achieved laparoscopically via enterotomy and trocar insertion into a jejunal loop.
- A duodenoscope was passed through the trocar to reach the papilla.
Findings:
- A guidewire was advanced laparoscopically into the cystic duct, enabling bile duct cannulation via the rendez-vous technique.
- Successful endoscopic sphincterotomy and gallstone extraction were performed.
- Laparoscopic cholecystectomy was completed, and the enterotomy was sutured with an uneventful clinical course.
Implications:
- This technique offers a viable endoscopic access route for biliary interventions in patients with complex post-BPD anatomy.
- Laparoscopy-assisted ERCP provides a minimally invasive option for managing biliary complications after bariatric surgery.
- The described rendez-vous technique facilitates successful stone removal and sphincterotomy in challenging cases.
