Laparoscopy-Assisted ERCP after Biliopancreatic Diversion |
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Authors: | Massimiliano Mutignani Michele Marchese Andrea Tringali Roberto Maria Tacchino Daniele Matera Maurizio Foco Francesco Greco Guido Costamagna |
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Affiliation: | (1) Head Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, “A. Gemelli” University Hospital, Largo A. Gemelli 8, 00168 Rome, Italy;(2) Department of Surgery, Catholic University, Rome, Italy |
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Abstract: | Therapeutic biliary endoscopy after biliopancreatic diversion (BPD) for morbid obesity is not possible through the anatomical route. In the case of a long excluded afferent limb, the possibility to reach endoscopically the papilla through a surgical gastrostomy or jejunostomy has been reported. A case of laparoscopy-assisted ERCP performed 4 years after laparoscopic BPD with distal gastrectomy, is reported. Access to the papilla was obtained laparoscopically by enterotomy, insertion of a trocar into a jejunal loop 40 cm distal to the ligament of Treitz and passage of the duodenoscope through the trocar to the papilla. A guidewire was laparoscopically advanced into the cystic duct, and bile duct cannulation was achieved using the rendez-vous technique; endoscopic sphincterotomy and extraction of stones were successful. Laparoscopic cholecystectomy was performed and the enterotomy was sutured. The clinical course was uneventful. |
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Keywords: | Biliopancreatic diversion jaundice choledocholithiasis endoscopic retrgrade cholangiopancreatography (ERCP) laparoscopy jejunotomy endoscopy morbid obesity |
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