Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass
Background: Rapid weight loss following gastric bypass (GBP) predisposes to the development of gallstones, and in those who develop gallstone disease there is a high prevalence of common bile duct stones (CBDS). Furthermore, in these patients, CBDS are difficult to extract due to the altered upper g...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-12-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2021.789231/full |
| _version_ | 1818435927907762176 |
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| author | Agnieszka Popowicz Agnieszka Popowicz Susanne Sanamrad Bahman Darkahi Rebecka Zacharias Rebecka Zacharias Gabriel Sandblom Gabriel Sandblom |
| author_facet | Agnieszka Popowicz Agnieszka Popowicz Susanne Sanamrad Bahman Darkahi Rebecka Zacharias Rebecka Zacharias Gabriel Sandblom Gabriel Sandblom |
| author_sort | Agnieszka Popowicz |
| collection | DOAJ |
| description | Background: Rapid weight loss following gastric bypass (GBP) predisposes to the development of gallstones, and in those who develop gallstone disease there is a high prevalence of common bile duct stones (CBDS). Furthermore, in these patients, CBDS are difficult to extract due to the altered upper gastrointestinal anatomy following GBP. The aim of the present study was to assess outcome after various management methods applied in the counties of Stockholm and Uppsala, Sweden.Methods: Data from the Swedish Register for Gallstone Surgery and ERCP (GallRiks) and the Swedish Obesity Surgery Register (SoReg) were crossmatched to identify all patients who had undergone gallstone surgery after GBP, where CBDS were found at intraoperative cholangiography, in the Stockholm and Uppsala counties 2009–2013. A retrospective review of patient records was performed for all patients identified.Results: In all, 55 patients were identified. These were managed as follows: expectancy (N = 11); transgastric ERCP (N = 2); laparoscopic choledochotomy (N = 3); open choledochotomy (N = 5); transcystic stone extraction (N = 12); and other approach (N = 13). In nine cases, data on management could not be found. There were nine cases of minor postoperative complication. No retained stones were registered. The operation time was longer for transgastric ERCP (p = 0.002), and the postoperative stay was longer following open and laparoscopic choledochotomy (p < 0.001). There was no statistically significant difference between any of the methods regarding the incidence of postoperative complications (p = 0.098).Discussion: Further development of techniques for managing CBDS discovered in patients undergoing cholecystectomy after previous GBP are needed, as well as more comparative studies with greater statistical power. |
| first_indexed | 2024-12-14T17:00:40Z |
| format | Article |
| id | doaj.art-9ae8eca0e26441f08db6051011993549 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-14T17:00:40Z |
| publishDate | 2021-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-9ae8eca0e26441f08db60510119935492022-12-21T22:53:51ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2021-12-01810.3389/fsurg.2021.789231789231Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric BypassAgnieszka Popowicz0Agnieszka Popowicz1Susanne Sanamrad2Bahman Darkahi3Rebecka Zacharias4Rebecka Zacharias5Gabriel Sandblom6Gabriel Sandblom7Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, SwedenSection of Acute and Trauma Surgery, Karolinska University Hospital, Stockholm, SwedenDepartment of Emergency Medicine, Capio S:t Göran Hospital, Stockholm, SwedenDepartment of Surgery, Enköping Hospital, Enköping, SwedenDepartment of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, SwedenDepartment of Surgery, Södersjukhuset, Stockholm, SwedenDepartment of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, SwedenDepartment of Surgery, Södersjukhuset, Stockholm, SwedenBackground: Rapid weight loss following gastric bypass (GBP) predisposes to the development of gallstones, and in those who develop gallstone disease there is a high prevalence of common bile duct stones (CBDS). Furthermore, in these patients, CBDS are difficult to extract due to the altered upper gastrointestinal anatomy following GBP. The aim of the present study was to assess outcome after various management methods applied in the counties of Stockholm and Uppsala, Sweden.Methods: Data from the Swedish Register for Gallstone Surgery and ERCP (GallRiks) and the Swedish Obesity Surgery Register (SoReg) were crossmatched to identify all patients who had undergone gallstone surgery after GBP, where CBDS were found at intraoperative cholangiography, in the Stockholm and Uppsala counties 2009–2013. A retrospective review of patient records was performed for all patients identified.Results: In all, 55 patients were identified. These were managed as follows: expectancy (N = 11); transgastric ERCP (N = 2); laparoscopic choledochotomy (N = 3); open choledochotomy (N = 5); transcystic stone extraction (N = 12); and other approach (N = 13). In nine cases, data on management could not be found. There were nine cases of minor postoperative complication. No retained stones were registered. The operation time was longer for transgastric ERCP (p = 0.002), and the postoperative stay was longer following open and laparoscopic choledochotomy (p < 0.001). There was no statistically significant difference between any of the methods regarding the incidence of postoperative complications (p = 0.098).Discussion: Further development of techniques for managing CBDS discovered in patients undergoing cholecystectomy after previous GBP are needed, as well as more comparative studies with greater statistical power.https://www.frontiersin.org/articles/10.3389/fsurg.2021.789231/fullERCP (cholangiopancreatography)gastric bypasscommon bile duct stonescholangiotomytranscystic stone extraction |
| spellingShingle | Agnieszka Popowicz Agnieszka Popowicz Susanne Sanamrad Bahman Darkahi Rebecka Zacharias Rebecka Zacharias Gabriel Sandblom Gabriel Sandblom Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass Frontiers in Surgery ERCP (cholangiopancreatography) gastric bypass common bile duct stones cholangiotomy transcystic stone extraction |
| title | Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass |
| title_full | Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass |
| title_fullStr | Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass |
| title_full_unstemmed | Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass |
| title_short | Management of Common Bile Duct Stones Encountered During Cholecystectomy in Patients With Previous Gastric Bypass |
| title_sort | management of common bile duct stones encountered during cholecystectomy in patients with previous gastric bypass |
| topic | ERCP (cholangiopancreatography) gastric bypass common bile duct stones cholangiotomy transcystic stone extraction |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2021.789231/full |
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