Atresia pilórica / Pyloric Atresia

Introducción: La atresia pilórica es una afección rara, que en el 40-50 por ciento de los casos se asocia a otras anomalías, frecuentemente con la epidermolisis bullosa, asociación conocida como síndrome de Carmi. Objetivo: Informar sobre la evolución de una paciente tratada por atresia pilórica que tenía además una epidermolisis bullosa. Presentación del caso: Recién nacida con antecedentes prenatales de polihidramnios, parto eutócico a las 30,4 semanas, sepsis ovular materna, peso al nacer 1430 gramos; múltiples lesiones en piel, ampollosas y aplasia cutis en pierna izquierda. Se ventiló desde sala de partos, La paciente no toleró la alimentación enteral mínima. Se realizó estudio radiográfico y no se visualizó paso de contraste al píloro. Se diagnosticó una atresia pilórica y se operó al cuarto día de nacida. La paciente tenía una atresia pilórica tipo 2: sustitución del tejido pilórico por tejido fibroso. Se hizo una gastroduodenostomía. En su evolución se incrementaron por día las lesiones en piel, y tuvo reapertura del ductus arterioso, trastornos hidroelectrolíticos, y hemidinámicos que provocaron el fallecimiento a los 14 días de nacida. Conclusiones: La atresia pilórica es una afección muy rara, que debe tenerse en cuenta en recién nacidos con epidermolisis bullosa por la frecuente asociación entre estas dos afecciones; además, cuando existen antecedentes de polihidramnios y no tolerancia a la alimentación enteral. Los pacientes con la asociación atresia pilórica y epidermolisis bullosa generalmente presentan una evolución desfavorable (AU)

Introduction: Pyloric atresia is a rare condition, which in 40-50 percent of cases is associated with other anomalies, often with epidermolysis bullosa, an association known as Carmi syndrome. Objective: To report on the evolution of a patient treated due to pyloric atresia who also had epidermolysis bullosa. Case presentation: Female newborn with prenatal history of polyhydramnios, eutocic delivery at 30.4 weeks, maternal ovular sepsis, birth weight 1430 grams, with multiple skin lesions, blisters and aplasia cutis in the left leg. She was ventilated from the delivery room. The patient did not tolerate minimal enteral feeding. A radiographic study was performed and no contrast passage to the pylorus was visualized. Pyloric atresia was diagnosed and operated on the fourth day of birth. The patient had pyloric atresia type 2: replacement of pyloric tissue by fibrous tissue. A gastroduodenostomy was done. In its evolution, skin lesions increased per day and reopening of the ductus arteriosus was performed, she had hydroelectrolyte disorders, and hemidynamic disorders that caused death at 14 days of birth. Conclusions: Pyloric atresia is a very rare condition, which should be taken into account in newborns with epidermolysis bullosa due to the frequent association between these two conditions, also when there is a history of polyhydramnios and no tolerance to enteral feeding. Patients with pyloric atresia and epidermolysis bullosa usually have an unfavorable outcome(AU)

Atresia pilórica / Pyloric Atresia

Introducción: La atresia pilórica es una afección rara, que en el 40-50 por ciento de los casos se asocia a otras anomalías, frecuentemente con la epidermolisis bullosa, asociación conocida como síndrome de Carmi. Objetivo: Informar sobre la evolución de una paciente tratada por atresia pilórica que tenía además una epidermolisis bullosa. Presentación del caso: Recién nacida con antecedentes prenatales de polihidramnios, parto eutócico a las 30,4 semanas, sepsis ovular materna, peso al nacer 1430 gramos; múltiples lesiones en piel, ampollosas y aplasia cutis en pierna izquierda. Se ventiló desde sala de partos, La paciente no toleró la alimentación enteral mínima. Se realizó estudio radiográfico y no se visualizó paso de contraste al píloro. Se diagnosticó una atresia pilórica y se operó al cuarto día de nacida. La paciente tenía una atresia pilórica tipo 2: sustitución del tejido pilórico por tejido fibroso. Se hizo una gastroduodenostomía. En su evolución se incrementaron por día las lesiones en piel, y tuvo reapertura del ductus arterioso, trastornos hidroelectrolíticos, y hemidinámicos que provocaron el fallecimiento a los 14 días de nacida. Conclusiones: La atresia pilórica es una afección muy rara, que debe tenerse en cuenta en recién nacidos con epidermolisis bullosa por la frecuente asociación entre estas dos afecciones; además, cuando existen antecedentes de polihidramnios y no tolerancia a la alimentación enteral. Los pacientes con la asociación atresia pilórica y epidermolisis bullosa generalmente presentan una evolución desfavorable(AU)

Introduction: Pyloric atresia is a rare condition, which in 40-50 percent of cases is associated with other anomalies, often with epidermolysis bullosa, an association known as Carmi syndrome. Objective: To report on the evolution of a patient treated due to pyloric atresia who also had epidermolysis bullosa. Case presentation: Female newborn with prenatal history of polyhydramnios, eutocic delivery at 30.4 weeks, maternal ovular sepsis, birth weight 1430 grams, with multiple skin lesions, blisters and aplasia cutis in the left leg. She was ventilated from the delivery room. The patient did not tolerate minimal enteral feeding. A radiographic study was performed and no contrast passage to the pylorus was visualized. Pyloric atresia was diagnosed and operated on the fourth day of birth. The patient had pyloric atresia type 2: replacement of pyloric tissue by fibrous tissue. A gastroduodenostomy was done. In its evolution, skin lesions increased per day and reopening of the ductus arteriosus was performed, she had hydroelectrolyte disorders, and hemidynamic disorders that caused death at 14 days of birth. Conclusions: Pyloric atresia is a very rare condition, which should be taken into account in newborns with epidermolysis bullosa due to the frequent association between these two conditions, also when there is a history of polyhydramnios and no tolerance to enteral feeding. Patients with pyloric atresia and epidermolysis bullosa usually have an unfavorable outcome(AU)

Effects of different gastrointestinal reconstruction techniques on nutrition, anemia, and quality of life in laparoscopic distal gastrectomy for gastric cancer.

PURPOSE: To explore the effect of different gastrointestinal reconstruction techniques on laparoscopic distal gastrectomy of gastric cancer on the nutritional and anemia status, and quality of life (QoL) of patients. METHODS: Eligible patients were randomly divided into three groups (n=36/group): Billroth I anastomosis group, Billroth II combined with Braun anastomosis group, and Roux-en-Y anastomosis group. Related indicators were compared and analyzed. RESULTS: The general data were comparable among the three groups (all P>0.05). Among the surgical-related indicators and postoperative recovery indicators, only the comparison of the operation time was statistically significant (P=0.004). The follow-up time was 5~36 months (average 27.9 months). In terms of nutritional and anemia indicators, only the differences in the levels of prealbumin, hemoglobin and serum ferritin in 24 months after operation showed significant differences (P=0.015, P=0.003, P=0.005, respectively). There were no significant differences in hospital readmission rate, overall survival, and QoL among the three groups (all P>0.05). CONCLUSIONS: In laparoscopic gastrectomy for stage II~III distal gastric cancer, Billroth I anastomosis has shorter operation time than Billroth II combined with Braun anastomosis and Roux-en-Y anastomosis and advantages in the improvement of nutritional status and anemia recovery.

EUS-guided gastroenterostomy versus duodenal stent placement and surgical gastrojejunostomy for the palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis.

PURPOSE: Malignant gastric outlet obstruction (GOO) is associated with significant morbidity and decreased quality of life, thereby necessitating effective and safe palliative treatment. As such, we sought to compare endoscopic ultrasound-guided gastroenterostomy (EUS-GE) versus duodenal stent (DS) placement and surgical gastrojejunostomy (SGJ) for palliation of malignant GOO. METHODS: Searches of electronic databases were performed to identify studies comparing EUS-GE versus DS and/or SGJ for palliative treatment of GOO. Outcomes included technical and clinical success, severe adverse events (SAEs), rate of stent obstruction (including tumor ingrowth), length of hospital stay (LOS), reintervention, and 30-day all-cause mortality. Differences in dichotomous and continuous outcomes were reported as risk difference and mean difference, respectively. RESULTS: Seven studies (n = 513 patients) were included. When compared to DS placement, EUS-GE was associated with a higher clinical success, fewer SAEs, decreased stent obstruction, lower rate of tumor ingrowth, and decreased need for reintervention. Compared to SGJ, EUS-GE was associated with a lower technical success; however, LOS was significantly decreased. All other outcomes including clinical success, SAEs, reintervention rate, and 30-day mortality were not significantly different between an EUS-guided versus surgical approach. CONCLUSIONS: EUS-GE was associated with significantly improved outcomes compared to DS placement for palliative treatment of malignant GOO. Despite SGJ possessing a higher technical success compared to EUS-GE, LOS was significantly longer with no difference in clinical success or rate of adverse events.

Laparoscopic Completion Total Gastrectomy for Remnant Gastric Cancer.

Background: Remnant gastric cancer (RGC) is increasing due to past use of subtotal gastrectomy to treat benign diseases, improvements in the detection of gastric cancer, and increased survival rates after gastrectomy for gastric cancer. Laparoscopic access provides the advantages and benefits of minimally invasive surgery. However, laparoscopic completion total gastrectomy (LCTG) for RGC is technically demanding, even for experienced surgeons. Because of its rarity and heterogeneity, no standard surgical strategy has been established and few surgeons will develop technical expertise to carry out this procedure. Aim: To describe our standard technique, giving surgeons a head start in LCTG and report the early experience with this stepwise approach. Materials and Methods: We detail all the steps involved in the procedure, including trocar placement and surgical description. Results: Between 2009 and 2019, a total of 8 patients with past history of RGC were operated with this technique. All patients had been previously operated by open method, 7 due to peptic ulcer disease and 1 due to gastric cancer. Their mean age at the time of the first surgery was 38.9 years (range 25-56 years) and the mean interval between the first and the second gastrectomy was 32.1 years (range 13.6-49). Billroth II was the previous reconstruction in all cases. A 5-trocar technique was used followed by total gastrectomy with side-to-side stapled intracorporeal esophagojejunostomy anastomosis and Roux-en-Y reconstruction. The mean operation time was 272 minutes (range 180-330) and median blood loss was 247 mL (range 50-500). There was no conversion and no major intraoperative complication. Major postoperative complications occurred in 3 patients. Conclusion: Completion total gastrectomy for RGC is a morbid procedure and laparoscopic access is technically feasible, hopefully carrying the benefits of faster recovery, reduced postoperative pain, and wound complications. By standardizing the approach, the learning curve may be shortened and better results achieved.

EUS-guided gastroenterostomy: Initial experience in a brazilian tertiary center.

INTRODUCTION: EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO). Our aim was to evaluate the outcomes of this technique in our initial experience. METHODS: Patients with GOO from our institute were included. Technical success was defined as the successful creation of a gastroenterostomy. Clinical success was defined as the ability to tolerate a soft diet after the procedure. We assessed adverse events and diet tolerance 1 month after the procedure. RESULTS: Three patients were included. Technical and clinical success was achieved in all cases. There were no adverse events and good diet tolerance was observed 1 month after the procedure in the included patients. CONCLUSION: EUS-GE is a promising treatment for patients with GOO.

Billroth I technique application after resection of gastric leiomyoma in a dog

Background: Gastric neoplasia is rare, corresponding to less than 1% of cases, with a lower prevalence of those involving smooth muscle tissues. In these cases, clinical signs worsen in the occurrence of pyloric obstruction, leading to clinical manifestations such as chronic emesis. The exeresis of the neoplasm is promoted as a therapeutic measure to reestablish gastrointestinal flow. There partial gastrectomy followed by gastroduodenal anastomosis, using the Billroth I technique, is among the available surgical techniques. The therapeutic success of the Billroth I technique after pylorectomy was reported in a dog with gastric leiomyoma. Case: A 9-year-old male Poodle dog, weighing 9.5 kg, was referred for clinical evaluation with a history of chronic vomiting starting three months ago, progressive weight loss, and melena, previously treated by another Veterinarian as idiopathic gastroenteritis. The physical evaluation of the animal showed a state of normal consciousness, body score 4/9, pale ocular and oral mucous membranes, respiratory rate 20 mpm, heart rate 166 bpm, a rectal temperature of 37.9°C, and dehydration degree of 8.0%. Blood count showed normocytic normochromic anemia and leukocytosis with shift to the right. Radiographic and endoscopic examinations were not noteworthy. Endoscopic biopsy after a histopathological evaluation showed no cellular or tissue atypia. On the other hand, abdominal ultrasound assessment revealed thickening with loss of echotexture and definition of the muscular layer of the gastric wall, pyloric and duodenum region compatible with benign antral muscle hypertrophy and/or pyloric neoplasia. The animal worsened 5 days after the initial treatment, with progressive episodes of emesis and melena, opting for an exploratory laparotomy. A mass of firm consistency measuring approximately 2.5 × 6.0 cm in diameter was found in the pyloric region, opting for a pylorectomy. The excised fragment was sent for histopathological...(AU)

El carácter científico de la Cirugía. Historia y Filosofía / The Scientific Nature of Surgery. History and Philosophy

RESUMEN ¿Se puede hablar de ciencia cuando nos referimos a la cirugía? No, de acuerdo con la epistemología clásica, que dice que para que una disciplina sea considerada científica debe alcanzar requisitos que la cirugía parecería no cumplir. Esto es, ser parte de un paradigma y crear conocimiento científico. Por lo que, si queremos afirmar la cientificidad de la cirugía, debemos investigar la existencia de ejem plares que podrían ser paradigmáticos, ya que son ellos los que fundamentan su estructura epistémi ca. Junto a esto debemos demostrar que su práctica crea conocimiento científico. Para ello, postulamos cinco objetivos que la cirugía debe cumplir. Además, a los personajes históricos clásicos a quienes se les atribuye haber fundado la cirugía moderna ‒Ambrosio Paré y John Hunter‒, solo pudieron alcanzar los tres primeros. Pero esto no basta para que se considere a la cirugía como parte de la ciencia. Debimos avanzar en la historia y encontrar esos ejemplares paradigmáticos. El primero corresponde al trabajo de investigación en fase animal, previa a la realización de la primera gastrectomía exitosa rea lizada en seres humanos por el cirujano alemán Theodor Billroth, en el año 1882. El segundo corres ponde a la investigación en fisiología tiroidea realizada por Emil T. Kocher, con la que ganó el premio Nobel en Medicina y Fisiología en año 1909. Se hace un análisis del desarrollo epistémico de la cirugía a partir de ellos y se evalúan las consecuen cias mediante el concepto de ciclo epistémico. Hipótesis clave para entender la creación del conoci miento científico a partir de disciplinas técnicas como la cirugía.

ABSTRACT Can we talk about science when we speak about surgery? Not, accordingly to classical epistemology. To consider a discipline as scientific, it must meet certain requirements that surgery would not seem to satisfy: being part of a paradigm and creating scientific knowledge. Therefore, if we want to affirm the scientific nature of surgery, we must investigate the existence of exemplars that could be paradigmatic, since they are the ones that support its epistemic structure. Along with this, we must demonstrate that their practice creates scientific knowledge. We've postulated five objectives that surgery had to satisfy. We've seen in classic history, that the main characters which are considered founders of modern surgery -Ambrosio Pare and John Hunter- were only able to reach the first three, and as we'll see, were not enough to consider surgery as part of science. Moving forward in history, we are able to find the first paradigmatic exemplars. The first corresponds to the research work in the animal phase, prior to the first successful human gastrectomy performed by the German surgeon Theodor Billroth, in 1882. The second corresponds to the research in thyroid's physiology carried out by Emil T. Kocher; thanks to this, he won the Nobel Prize in medicine and phy siology in 1909. An analysis of the epistemic development of surgery is made from them, and the consequences are analyzed using the concept of the epistemic cycle. Those key hypotheses are important to understand the creation of scientific knowledge in technical disciplines as surgery.

EUS-guided gastroenterostomy: Initial experience in a brazilian tertiary center

SUMMARY INTRODUCTION: EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO). Our aim was to evaluate the outcomes of this technique in our initial experience. METHODS: Patients with GOO from our institute were included. Technical success was defined as the successful creation of a gastroenterostomy. Clinical success was defined as the ability to tolerate a soft diet after the procedure. We assessed adverse events and diet tolerance 1 month after the procedure. RESULTS: Three patients were included. Technical and clinical success was achieved in all cases. There were no adverse events and good diet tolerance was observed 1 month after the procedure in the included patients. CONCLUSION: EUS-GE is a promising treatment for patients with GOO.

RESUMO INTRODUÇÃO: A gastroenterostomia ecoguiada é um novo procedimento para paliação da obstrução maligna gastroduodenal. Nosso objetivo foi avaliar os resultados dessa técnica em nossa experiência inicial. MÉTODOS: Foram incluídos pacientes com obstrução maligna gastroduodenal de nossa instituição. O sucesso técnico foi definido como a realização adequada de uma gastroenterostomia. O sucesso clínico foi definido como boa aceitação de dieta pastosa durante a internação. Os eventos adversos e a aceitação alimentar foram avaliados um mês após o procedimento. RESULTADOS: Três pacientes foram incluídos. Os sucessos técnico e clínico foram alcançados em todos os casos. Não houve eventos adversos e a aceitação alimentar permaneceu adequada um mês após o procedimento nos pacientes incluídos. CONCLUSÃO: O EUS-GE é um tratamento promissor para pacientes com obstrução maligna gastroduodenal.

Billroth I technique application after resection of gastric leiomyoma in a dog

Background: Gastric neoplasia is rare, corresponding to less than 1% of cases, with a lower prevalence of those involving smooth muscle tissues. In these cases, clinical signs worsen in the occurrence of pyloric obstruction, leading to clinical manifestations such as chronic emesis. The exeresis of the neoplasm is promoted as a therapeutic measure to reestablish gastrointestinal flow. There partial gastrectomy followed by gastroduodenal anastomosis, using the Billroth I technique, is among the available surgical techniques. The therapeutic success of the Billroth I technique after pylorectomy was reported in a dog with gastric leiomyoma. Case: A 9-year-old male Poodle dog, weighing 9.5 kg, was referred for clinical evaluation with a history of chronic vomiting starting three months ago, progressive weight loss, and melena, previously treated by another Veterinarian as idiopathic gastroenteritis. The physical evaluation of the animal showed a state of normal consciousness, body score 4/9, pale ocular and oral mucous membranes, respiratory rate 20 mpm, heart rate 166 bpm, a rectal temperature of 37.9°C, and dehydration degree of 8.0%. Blood count showed normocytic normochromic anemia and leukocytosis with shift to the right. Radiographic and endoscopic examinations were not noteworthy. Endoscopic biopsy after a histopathological evaluation showed no cellular or tissue atypia. On the other hand, abdominal ultrasound assessment revealed thickening with loss of echotexture and definition of the muscular layer of the gastric wall, pyloric and duodenum region compatible with benign antral muscle hypertrophy and/or pyloric neoplasia. The animal worsened 5 days after the initial treatment, with progressive episodes of emesis and melena, opting for an exploratory laparotomy. A mass of firm consistency measuring approximately 2.5 × 6.0 cm in diameter was found in the pyloric region, opting for a pylorectomy. The excised fragment was sent for histopathological...

Rectus abdominis muscle flap for repair of the gastrojejunal leakage afterdistal gastrectomy with Billroth II anastomosis for gastric cancer.

Anastomotic leakages at the gastrojejunostomy site are difficult to repair, due to complex gastrointestinal anatomy. This is the first study reporting clinical use of rectus abdominis muscle (RAM) flap for repair of gastrojejunostomy leakage. A patient with leakage of gastrojejunostomy after distal gastrectomy with Billrroth II anastomosis for gastric cancer underwent repair using left RAM flap, based on superior epigastric artery. Rectus abdominis muscle flap, after being harvested was then anchored to the edges of the leak of gastrojejunostomy with few interrupted 2-0 vicryl sutures. Gastrojejunostomy leak sealed in the two cases. Rectus abdominis muscle flap for closure of gastrointestinal defect is a simple, technically easy and dependable procedure, which can be performed, quickly in critically ill patients. It can be used for repair of a large gastrointestinal defect with friable edges when omentum is not available or when other conventional methods are impractical.

Rectus abdominis muscle flap for repair of the gastrojejunal leakage after distal gastrectomy with Billroth II anastomosis for gastric cancer / Colgajo del músculo recto abdominal para reparación de la dehiscencia gastroyeyunal luego de gastrectomía distal con anastomosis Billroth II por cáncer gástrico

Anastomotic leakages at the gastrojejunostomy site are difficult to repair, due to complex gastrointestinal anatomy. This is the first study reporting clinical use of rectus abdominis muscle (RAM) flap for repair of gastrojejunostomy leakage. A patient with leakage of gastrojejunostomy after distal gastrectomy with Billrroth II anastomosis for gastric cancer underwent repair using left RAM flap, based on superior epigastric artery. Rectus abdominis muscle flap, after being harvested was then anchored to the edges of the leak of gastrojejunostomy with few interrupted 2-0 vicryl sutures. Gastrojejunostomy leak sealed in the two cases. Rectus abdominis muscle flap for closure of gastrointestinal defect is a simple, technically easy and dependable procedure, which can be performed, quickly in critically ill patients. It can be used for repair of a large gastrointestinal defect with friable edges when omentum is not available or when other conventional methods are impractical.

Las dehiscencias anastomóticas en el sitio de gastroyeyunostomía son difíciles de reparar, debido a la compleja anatomía gastrointestinal. Este es el primer estudio que comunica el uso clínico del colgajo del músculo recto abdominal (MRA) para la reparación de la dehiscencia de gastroyeyunostomía. A un paciente con dehiscencia de gastroyeyunostomía, luego de una gastrectomía distal con anastomosis Billrroth II para cáncer gástrico, se le realizó una reparación utilizando colgajo izquierdo del MRA, basado en la arteria epigástrica superior. El colgajo del músculo recto abdominal, después de ser extraído, se fijó a los bordes de la dehiscencia de la gastroyeyunostomía con pocas suturas de vicryl 2-0 interrumpidas. La dehiscencia de la gastroyeyunostomía fue sellada. El colgajo del músculo reto abdominal para el cierre del defecto gastrointestinal es un procedimiento simple, técnicamente fácil y confiable, que puede realizarse rápidamente en pacientes críticamente enfermos. Se puede utilizar para la reparación de un gran defecto gastrointestinal con bordes friables cuando el omento no está disponible o cuando otros métodos convencionales no son prácticos.

Evaluation tool for a gastroenterostomy simulated training1.

PURPOSE: To create a checklist to evaluate the performance and systematize the gastroenterostomy simulated training. METHODS: Experimental longitudinal study of a quantitative character. The sample consisted of twelve general surgery residents. The training was divided into 5 sessions and consisted of participation in 20 gastroenterostomys in synthetic organs. The training was accompanied by an experienced surgeon who was responsible for the feedback and the anastomoses evaluation. The anastomoses evaluated were the first, fourth, sixth, eighth and tenth. A 10 item checklist and the time to evaluate performance were used. RESULTS: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0,295 showed a high linear correlation between time variables and Checklist. The average Checklist score went from 6.8 to 9 points. CONCLUSION: The proposed checklist can be used to evaluate the performance and systematization of a simulated training aimed at configuring a gastroenterostomy.

Evaluation tool for a gastroenterostomy simulated training

Abstract Purpose: To create a checklist to evaluate the performance and systematize the gastroenterostomy simulated training. Methods: Experimental longitudinal study of a quantitative character. The sample consisted of twelve general surgery residents. The training was divided into 5 sessions and consisted of participation in 20 gastroenterostomys in synthetic organs. The training was accompanied by an experienced surgeon who was responsible for the feedback and the anastomoses evaluation. The anastomoses evaluated were the first, fourth, sixth, eighth and tenth. A 10 item checklist and the time to evaluate performance were used. Results: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0,295 showed a high linear correlation between time variables and Checklist. The average Checklist score went from 6.8 to 9 points. Conclusion: The proposed checklist can be used to evaluate the performance and systematization of a simulated training aimed at configuring a gastroenterostomy.

Rendez-Vous laparoendoscopic after ERCP failure in patient with Billroth II gastrectomy / Laparoscopía por Rendez-Vous luego de falla de CPRE en un paciente con gastectomía Billroth II

Endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice in patients with choledocholithiasis. However, despite its high success rate, in some cases it is not successful, requiring alternative therapy. Billroth II partial gastrectomy is a condition associated with an important failure rate of ERCP. When endoscopic treatment fails, surgical exploration of the bile duct is the most common approach. However, the surgery is related to a greater complexity of execution and morbimortality. We describe the case of a patient with choledocholithiasis and Billroth II partial gastrectomy, submitted to the combined treatment called rendez-vous laparoendoscopic, after failure of ERCP, which unites in a single stage the endoscopic treatment of choledocholithiasis and laparoscopic removal of the gallbladder. We conclude that this therapeutic approach was effective, safe, with low cost and without complications.

La colangiopancreatografía endoscópica retrógrada (CPRE) es el tratamiento de elección en pacientes portadores de coledocolitiasis. Sin embargo, a pesar de su elevada tasa de éxito, en algunos casos no es exitosa, exigiendo terapia alternativa. La gastrectomía parcial con reconstrucción a Billroth II es una condición asociada a la importante tasa de fracaso de la CPRE. Cuando el tratamiento endoscópico falla, la exploración quirúrgica de la vía biliar es un enfoque más común. Sin embargo, la cirugía se relaciona con una mayor complejidad de ejecución y morbimortalidad. Describimos el caso de un paciente con coledocolitiasis y gastrectomía parcial con reconstrucción a Billroth II, sometido al tratamiento combinado denominado rendez-vous laparoendoscópico tras fallo de la CPRE, que une en una sola etapa el tratamiento endoscópico de la coledocolitiasis y la retirada laparoscópica de la vesícula biliar. Llegamos a la conclusión de que este enfoque terapéutico fue eficaz, seguro, de bajo costo y sin complicaciones.

Rendez-Vous laparoendoscopic after ERCP failure in patient with Billroth II gastrectomy.

Endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice in patients with choledocholithiasis. However,despite its high success rate, in some cases it is not successful, requiring alternative therapy. Billroth II partial gastrectomy is a condition associated with an important failure rate of ERCP. When endoscopic treatment fails, surgical exploration of the bile duct is the most common approach. However, the surgery is related to a greater complexity of execution and morbimortality. We describe the case of a patient with choledocholithiasis and Billroth II partial gastrectomy, submitted to the combined treatment called rendez-vous laparoendoscopic, after failure of ERCP, which unites in a single stage the endoscopic treatment of choledocholithiasis and laparoscopic removal of the gallbladder. We conclude that this therapeutic approach was effective, safe, with low cost and without complications.