ABSTRACT
Background: Gastrostomy is a widely used procedure that aims to obtain access to the stomach. Its purpose may be feeding or gastric decompression. Currently, the most common techniques are endoscopic and radiologic. Sometimes, these accesses are not available due to technical or patient-specific factors. In these cases, laparoscopic and percutaneous approaches combined could be an option. The aim of this study was to describe a laparoscopic-percutaneous combined gastrostomy procedure, feasibility, and complications. Materials and Methods: Retrospective descriptive observational study. All patients underwent laparoscopic-percutaneous combined gastrostomy required for feeding or decompressive gastrostomy. We analyzed variables: demographics, surgical indication, operation time, hospitalization stay, success, and morbidity/mortality associated to the procedure. Results: A total of n = 17 patients were recruited (58.8% women and 41.2% men), with mean age of 53. Regarding the indications of laparoscopic-percutaneous combined gastrostomy, 47% were due to upper gastrointestinal/head and neck tumor, 29.4% stomach location in a retrocostal position, 17.7% colonic interposition, and 5.9% acute gastric dilation of remnant after Roux-en-Y gastric bypass. The mean time of the procedure was 25 minutes, and mean hospitalization stay was 1.2 days. The success of the procedure was 100%. No complications and mortality associated with the procedure were reported. Conclusion: Laparoscopic-percutaneous combined gastrostomy is fast, feasible, safe, and cost effective. It is an option in patients where it is not possible to perform standard minimally invasive approaches.
Subject(s)
Gastric Bypass , Laparoscopy , Female , Gastrostomy , Humans , Male , Retrospective Studies , StomachABSTRACT
Background: Gallbladder stones are a very common disease, with a prevalence of 21.9% in Argentina. The incidence of common bile duct stones (CBDS) varies with age and with the clinical presentation; â¼3%-10% of patients with gallbladder lithiasis have concomitant choledocholithiasis. In the past decades, the development of ultrasound and magnetic resonance cholangiography and endoscopic ultrasound has expanded for the preoperative diagnosis of gallbladder lithiasis. Materials and Methods: We describe the step-by-step technique using the single-operator cholangioscope (pSOC) (SpyGlass™ Discover; Boston Scientific, Natick, MA) under laparoscopic guidance, in a patient with huge stones in the bile duct that was treated with a choledocotomy. Results: The patient underwent the procedure well and the closure of the bile duct was with a primary suture. The current devices, standard cholangioscopes or bronchoscopes, only have a two-way deflection. This problem might be solved with the introduction of a new pSOC device (SpyGlass Discover; Boston Scientific). Conclusion: In conclusion, the combination of laparoscopy and pSOC is a feasible, safe, and effective technique for the treatment of CBDS, and may be considered as an alternative approach in clinical cases where gastrointestinal anatomy is altered or when endoscopic retrograde cholangio-pancreatography (ERCP) failed. pSOC has the potential to reduce peri-procedural adverse events and costs.