Laparoscopic transcystic and hybrid transgastric rendezvous technique for common bile duct lithiasis after gastric bypass
Epublication WebSurg.com, Dec 2014;14(12). URL: http://websurg.com/doi/vd01en4360
Common bile duct lithiasis has become a challenging problem in patients who have undergone a laparoscopic Roux-en-Y gastric bypass for morbid obesity. Altered anatomy due to gastric diversion and biliary limb reconstruction leads to a prolonged and complex access to the ampulla of Vater. Consequently, experienced endoscopists and double-balloon endoscopes are required, often making it impossible to successfully perform an endoscopic sphincterotomy as in this case. Here, we describe the case of a patient who had already been operated on for a gastric bypass and who presented with multiple past episodes of cholangitis because of common bile duct stones. A double-balloon endoscopic sphincterotomy failed leading to the decision of surgical treatment combining a hybrid technique of laparoscopic transgastric sphincterotomy with a transcystic common bile duct exploration.