Akademik Veri Yönetim Sistemi
The XII CONGRESS of The WORLD SOCIETY of EMERGENCY SURGERY, Antalya, Türkiye, 21 - 25 Ekim 2025, ss.128, (Özet Bildiri)
Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the standard intervention for choledocholithiasis. However, altered gastrointestinal anatomy after bariatric surgery poses significant technical challenges to conventional ERCP due to the inaccessibility of the papilla via standard duodenoscopy. Laparoscopy-assisted ERCP (LA-ERCP) has emerged as a viable alternative, enabling direct access to the excluded stomach for biliary interventions. Case Presentation: A 39-year-old female presented in December 2023 with abdominal pain and jaundice. Magnetic resonance cholangiopancreatography (MRCP) revealed a distal common bile duct (CBD) stone. ERCP with sphincterotomy was performed, and due to an impacted stone, a 7F, 11 cm plastic stent was placed. Post-ERCP pancreatitis developed, which resolved with medical management. During the same admission, laparoscopic cholecystectomy was performed. In May 2025, the patient underwent gastric bypass surgery for obesity. In August 2025, she presented again with abdominal pain, and laboratory tests revealed elevated cholestatic enzymes. MRCP demonstrated calculi both proximal and distal to the existing CBD stent. Given her altered anatomy, LA-ERCP was planned. During laparoscopy, the remnant stomach was identified and anchored to the anterior abdominal wall with two sutures. A gastrotomy was created, and a transgastric trocar was inserted, allowing the introduction of a conventional duodenoscope via the remnant stomach. The ampulla was visualized; the old stent was removed, sphincterotomy was extended, and the CBD was swept with basket and balloon. One stone was extracted. The gastrotomy was closed with a 45 mm stapler. The patient was started on oral intake in the early postoperative period. Her postoperative course was uneventful, and she was discharged on postoperative day 3. Conclusion: In patients with altered anatomy after gastric bypass, LA-ERCP offers a safe and effective approach for the management of CBD stones. This technique provides direct access to the papilla, allowing the use of standard ERCP maneuvers. Reported technical and clinical success rates in the literature are high, and this case supports LA-ERCP as a valuable option in complex post-bariatric surgery scenarios. Keywords: Laparoscopy-assisted ERCP ,bariatric surgery