Laparoscopy-assisted ERCP: experience of a high-volume bariatric surgery center (with video)

Background: Laparoscopy-assisted ERCP (LAERCP) allows the diagnosis and treatment of biliopancreatic conditions in patients with Roux-en-Y- anatomy (RY). However, experience with this technique is limited. Objectives: To report on the experience with LAERCP in consecutive patients from high-volume bariatric surgery center and to evaluate success rates of ERCP with the laparoscopy-assisted approach. Design: Retrospective case series. Setting: High-volume bariatric surgery center. Patients: Consecutive patients undergoing LAERCP between 2003 and 2009. Intervention: LAERCP. Outcomes: Immediate/delayed complications, biliary/pancreatic duct cannulation, endoscopic/laparoscopic interventions, postprocedure hospital stay, procedure duration. Results: Ten patients Underwent LAERCP: 9 after Roux-en-Y gastric bypass (RYGB) and 1 after antrectomy with RY (9 female, 1 male; 9 white, 1 black). Indications for the procedure were choledocholithiasis (n=4), biliary stricture (n=3), and sphincter of Oddi dysfunction (n=3). Endoscopic access was obtained to the gastric remnant (n=9) or biliopancreatic limb (n=1). Biliary cannulation was successfully achieved in 9 of 10 patients, biliary sphincterotomy was performed in all, pancreatography in 3 of 3, and sphincter of Oddi manometry in 2. In 1 patient, a 3F pancreatic duct stent was placed prophylactically. Mild post-ERCP pancreatitis developed in 2 patients, and 1 patient had a pneumothorax intraoperatively that was treated successfully. The mean duration of the procedure was 89 minutes (range 41-245), and the median postprocedure hospital stay was 2 clays (mean 2.59, standard deviation 2.46). Limitations: Single-center, retrospective design. Conclusion: LAERCP is safe and successful for the diagnosis and therapy, of biliopancreatic conditions in patients with RY. It additionally, allows the diagnosis and treatment of internal hernias, a known complication of RYGB.