Laparoscopic transcystic common bile duct exploration versus transgastric endoscopic retrograde cholangiography during cholecystectomy after Roux-en-Y gastric bypass
Copyright © 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved..
BACKGROUND: 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.
OBJECTIVES: To compare outcomes following laparoscopic transcystic common bile duct exploration (LTCBDE) and laparoscopy-assisted transgastric ERC for CBDs during cholecystectomy in RYGB-operated patients.
SETTING: Swedish nationwide multi-registry study.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:19 |
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| Enthalten in: |
Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery - 19(2023), 8 vom: 02. Aug., Seite 882-888 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Zaigham, Hassan [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 15.08.2023 Date Revised 05.09.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.soard.2023.01.023 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM353767581 |
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| 100 | 1 | |a Zaigham, Hassan |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Laparoscopic transcystic common bile duct exploration versus transgastric endoscopic retrograde cholangiography during cholecystectomy after Roux-en-Y gastric bypass |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 15.08.2023 | ||
| 500 | |a Date Revised 05.09.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: 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 | ||
| 520 | |a OBJECTIVES: To compare outcomes following laparoscopic transcystic common bile duct exploration (LTCBDE) and laparoscopy-assisted transgastric ERC for CBDs during cholecystectomy in RYGB-operated patients | ||
| 520 | |a SETTING: Swedish nationwide multi-registry study | ||
| 520 | |a METHODS: 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 | ||
| 520 | |a RESULTS: 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) | ||
| 520 | |a CONCLUSIONS: 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Adult | |
| 650 | 4 | |a Adverse events | |
| 650 | 4 | |a Cholangiopancreatography | |
| 650 | 4 | |a Cholecystectomy | |
| 650 | 4 | |a Choledocholithiasis | |
| 650 | 4 | |a Endoscopic retrograde | |
| 650 | 4 | |a Gastric bypass | |
| 650 | 4 | |a Postoperative complications | |
| 650 | 4 | |a Treatment outcome | |
| 700 | 1 | |a Enochsson, Lars |e verfasserin |4 aut | |
| 700 | 1 | |a Ottosson, Johan |e verfasserin |4 aut | |
| 700 | 1 | |a Regnér, Sara |e verfasserin |4 aut | |
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