Accessing the common bile duct after Roux-en-Y gastric bypass.
We report on the clinical course of 2 patients who underwent laparoscopic Roux-en-Y gastric bypass for obesity and subsequently presented with biliary complications of choledocholithiasis in 1 case and sphincter of Oddi dysfunction in the other. The approach to these complex problems is described. Both patients underwent percutaneous transhepatic access to the common bile duct (CBD) for balloon sphincteroplasty. In 1 patient, percutaneous choledochoscopy was used for endoluminal visualization of the CBD. A literature review of the management of biliary problems after gastric bypass is presented. Although access to the CBD is limited, the options include percutaneous transhepatic instrumentation of the CBD, percutaneous or laparoscopic transgastric endoscopic retrograde cholangiopancreatography (ERCP), transenteric endoscopic cholangiopancreatography, ERCP using specialized endoscopes, and laparoscopic or open CBD exploration. Bile duct pathology after laparoscopic gastric bypass can be safely and effectively managed using a variety of techniques.
Ahmed
Ahmed R
AR
Department of Bariatric Surgery, University of Rochester Medical Center, Highland Hospital, Rochester, New York 14620, USA. ahmed_ahmed@urmc.rochester.edu
Husain
Syed
S
Saad
Nael
N
Patel
Nikhil C
NC
Waldman
David L
DL
O'Malley
William
W
D000328:Adult; D002404:Catheterization; D002763:Cholecystectomy; D042883:Choledocholithiasis / Q000209:etiology / Q000601:surgery*; D003135:Common Bile Duct; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000601:surgery*