Laparoscopic transcystic common bile duct exploration versus transgastric endoscopic retrograde cholangiography during cholecystectomy after Roux-en-Y gastric bypass

Hassan Zaigham, Lars Enochsson, Johan Ottosson, Sara Regnér

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)882-888
JournalSurgery for Obesity and Related Diseases
Volume19
Issue number8
Early online date2023
DOIs
Publication statusPublished - 2023

Subject classification (UKÄ)

  • Surgery

Free keywords

  • Adult
  • Adverse events
  • Cholangiopancreatography
  • Cholecystectomy
  • Choledocholithiasis
  • Endoscopic retrograde
  • Gastric bypass
  • Postoperative complications
  • Treatment outcome

Fingerprint

Dive into the research topics of 'Laparoscopic transcystic common bile duct exploration versus transgastric endoscopic retrograde cholangiography during cholecystectomy after Roux-en-Y gastric bypass'. Together they form a unique fingerprint.

Cite this