Shahab Hajibandeh1, Shahin Hajibandeh2, Munir Tarazi3, Moustafa Mansour4, Thomas Satyadas3. 1. Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, UK. shahab_hajibandeh@yahoo.com. 2. Department of General Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK. 3. Department of Hepatobiliary and Pancreatic Surgery, Manchester Royal Infirmary Hospital, Manchester, UK. 4. Department of Upper Gastrointestinal Surgery, North Manchester General Hospital, Manchester, UK.
Abstract
PURPOSE: To investigate the procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous Roux-en-Y gastric bypass (RYGB) surgery. MATERIALS AND METHODS: We performed a systematic review in accordance with PRISMA statement standards to identify all studies reporting procedural outcomes of laparoscopic-assisted ERCP in patients with previous RYGB. The ROBINS-I tool was used to assess the risk of bias of the included studies. Fixed-effect and random-effects models were applied to calculate pooled outcome data. RESULTS: A total of 17 case series, enrolling 256 patients, were included. The mean age of included patients was 49. The mean procedure time was 137 min (95% CI 102-172). In terms of procedural success rates, the overall technical success was 95.3% (95% CI 92.5-97.5, I2 = 0%), papillary access success was 95.3% (95% CI 92.5-97.5, I2 = 0%), cannulation success was 95.3% (95% CI 92.5-97.5, I2 = 0%), sphincterotomy success was 96.1% (95% CI 93.5-98.1, I2 = 0%), and stone removal success was 95.9% (95% CI 92.4-98.4, I2 = 0%). Conversion to open was required in 4.7% (95% CI 2.5-7.6, I2 = 0%). In terms of complications, pancreatitis occurred in 4.7% (95% CI 2.3-8, I2 = 17%), cholangitis in 1.7% (95% CI 0.5-3.6, I2 = 0%), and perforation in 3.7% (95% CI 1.8-6.3, I2 = 0%). The length of hospital stay was 3 days (95% CI 2-4). CONCLUSIONS: Laparoscopic-assisted ERCP seems to be feasible, effective, and a safe method to access the biliary tract in patients with previous RYGB as indicated by high technical success rates and low complication rates. There is a need for comparative evidence regarding outcomes of laparoscopic ERCP in comparison with alternative treatment options.
PURPOSE: To investigate the procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous Roux-en-Y gastric bypass (RYGB) surgery. MATERIALS AND METHODS: We performed a systematic review in accordance with PRISMA statement standards to identify all studies reporting procedural outcomes of laparoscopic-assisted ERCP in patients with previous RYGB. The ROBINS-I tool was used to assess the risk of bias of the included studies. Fixed-effect and random-effects models were applied to calculate pooled outcome data. RESULTS: A total of 17 case series, enrolling 256 patients, were included. The mean age of included patients was 49. The mean procedure time was 137 min (95% CI 102-172). In terms of procedural success rates, the overall technical success was 95.3% (95% CI 92.5-97.5, I2 = 0%), papillary access success was 95.3% (95% CI 92.5-97.5, I2 = 0%), cannulation success was 95.3% (95% CI 92.5-97.5, I2 = 0%), sphincterotomy success was 96.1% (95% CI 93.5-98.1, I2 = 0%), and stone removal success was 95.9% (95% CI 92.4-98.4, I2 = 0%). Conversion to open was required in 4.7% (95% CI 2.5-7.6, I2 = 0%). In terms of complications, pancreatitis occurred in 4.7% (95% CI 2.3-8, I2 = 17%), cholangitis in 1.7% (95% CI 0.5-3.6, I2 = 0%), and perforation in 3.7% (95% CI 1.8-6.3, I2 = 0%). The length of hospital stay was 3 days (95% CI 2-4). CONCLUSIONS: Laparoscopic-assisted ERCP seems to be feasible, effective, and a safe method to access the biliary tract in patients with previous RYGB as indicated by high technical success rates and low complication rates. There is a need for comparative evidence regarding outcomes of laparoscopic ERCP in comparison with alternative treatment options.
Authors: Matthew Connell; Warren Y L Sun; Valentin Mocanu; Jerry T Dang; Janice Y Kung; Noah J Switzer; Daniel W Birch; Shahzeer Karmali Journal: Surg Endosc Date: 2022-01-18 Impact factor: 3.453