Endoscopic retrograde cholangiopancreatography through laparoscopically created gastrotomy for the management of biliary complications of Roux-en-Y gastric bypass

Objective
The aim of this study was to evaluate the feasibility, safety, and surgical outcome of laparoscopically assisted endoscopic retrograde cholangiopancreatography (ERCP) through gastrotomy in patients who had undergone Roux-en-Y gastric bypass as a bariatric procedure and indicated for ERCP.
Patients and methods
The study included 12 patients who had undergone Roux-en-Y gastric bypass surgery in the past 1–4 years and developed biliary obstruction since 23.3±7 days (range: 13–36 days). The operative procedure involves laparoscopic creation of gastrotomy; a sterile ERCP scope was inserted through a 12-mm port site and passed manually under laparoscopic visualization through the gastrotomy orifice, and then sphincterotomy (papillotomy) and cannulation were performed. Preprocedural and postprocedural dye injection was performed to ensure the patency of biliary passages. The gastrotomy site was closed in two layers.
Results
Laparoscopic exploration was performed successfully in all patients, with successful adhesiolysis in three patients. In all patients, laparoscopic creation of gastrotomy in the gastric remnant was uneventful and successful, but gastrotomy site bleeding occurred in two cases and was controlled. Sphincterotomy was successful in all patients, but cannulation and injection of dye for intraoperative choledochography were performed successfully in 10 (83.3%) patients. Two patients required sphincter stenting. The mean operative time was 66.9±10.5 min (range: 55–90 min); the mean time until first ambulation and oral intake was 1.6 and 11.5 h, respectively, and the mean duration of postoperative hospital stay was 32.9 h. Eight minor postoperative complications were encountered.
Conclusion
Laparoscopic transgastrotomy ERCP is feasible and safe for the diagnosis and treatment of biliary complications secondary to bariatric surgery, with minimal treatable complications.