Details

Autor(en) / Beteiligte

• AlMasri, Samer
• Zenati, Mazen S.
• Papachristou, Georgios I.
• Slivka, Adam
• Sanders, Michael
• Chennat, Jennifer
• Rabinowitz, Mordechai
• Khalid, Asif
• Gelrud, Andres
• Nasr, John
• Sarkaria, Savreet
• Das, Rohit
• Lee, Kenneth K.
• Schraut, Wolfgang
• Hughes, Steve J.
• Moser, A. James
• Paniccia, Alessandro
• Hogg, Melissa E.
• Zeh, Herbert J.
• Zureikat, Amer H.

Titel

Laparoscopic-assisted ERCP following RYGB: a 12-year assessment of outcomes and learning curve at a high-volume pancreatobiliary center

Ist Teil von

• Surgical endoscopy, 2022, Vol.36 (1), p.621-630

Ort / Verlag

New York: Springer US

Erscheinungsjahr

2022

Quelle

SpringerLink

Beschreibungen/Notizen

• Introduction Treatment of pancreaticobiliary pathology following Roux-en-Y gastric bypass (RYGB) poses significant technical challenges. Laparoscopic-assisted endoscopic retrograde cholangiopancreatography (LA-ERCP) can overcome those anatomical hurdles, allowing access to the papilla. Our aims were to analyze our 12-year institutional outcomes and determine the learning curve for LA-ERCP. Methods A retrospective review of cases between 2007 and 2019 at a high-volume pancreatobiliary unit was performed. Logistic regression was used to identify predictors of specific outcomes . To identify the learning curve, CUSUM analyses and innovative methods for standardizing the surgeon’s timelines were performed. Results 131 patients underwent LA-ERCP (median age 60, 81% females) by 17 surgeons and 10 gastroenterologists. Cannulation of the papilla was achieved in all cases. Indications were choledocholithiasis (78%), Sphincter of Oddi dysfunction/Papillary stenosis (18%), management of bile leak (2%) and stenting/biopsy of malignant strictures (2%). Median total, surgical and ERCP times were 180, 128 and 48 min, respectively, and 47% underwent concomitant cholecystectomy. Surgical site infection developed in 9.2% and post-ERCP pancreatitis in 3.8%. Logistic regression revealed multiple abdominal operations and magnitude of BMI decrease (between RYGB and LA-ERCP) to be predictive of conversion to open approach. CUSUM analysis of operative time demonstrated a learning curve at case 27 for the surgical team and case 9 for the gastroenterology team. On binary cut analysis, 3–5 cases per surgeon were needed to optimize operative metrics. Conclusion LA-ERCP is associated with high success rates and low adverse events. We identify outcome benchmarks and a learning curve for new adopters of this increasingly performed procedure.