title: Temporary restoration of digestive continuity after laparoscopic gastric bypass to allow endoscopic sphincterotomy and retrograde exploration of the biliary tract.
abstract: The prevalence of morbid obesity is rapidly increasing worldwide. As surgery has been recognized to be the only effective treatment for morbid obesity, the number of bariatric procedure realized each year has dramatically increased. Among all the surgical options, gastric bypass in considered as the gold standard. A possible drawback of this operation is the difficult access to the excluded proximal intestinal tract and, consequently, to the biliary tract. As gallstone formation may be frequent after a rapid weight loss induced by surgery, surgeons could be frequently asked to face the need of exploration of the biliary tree after anatomical changes induced by this kind of surgery. Many technical solutions, mainly based on a combined laparoscopic and endoscopic approach, have been proposed by several authors to face this problem. We herein describe an original technique to allow endoscopic exploration of biliary tract after a laparoscopic gastric bypass based on temporary restoration of physiological digestive continuity followed by re-establishment of the Roux-en-Y loop.
authors.affiliation: Department of Surgery, Louis Mourier Hospital, Assistance Publique-Hopitaux de Paris, University Denis Diderot Paris VII, 178, rue des Renouillers, Colombes, 92701, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Saget
authors.forename: Enrico
authors.initials: E
authors.lastname: Facchiano
authors.forename: Pierre-Olivier
authors.initials: PO
authors.lastname: Bosset
authors.forename: Benjamin
authors.initials: B
authors.lastname: Castel
authors.forename: Philippe
authors.initials: P
authors.lastname: Ruszniewski
authors.forename: Simon
authors.initials: S
authors.lastname: Msika
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery; D000328:Adult; D000714:Anastomosis, Surgical; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D005260:Female; D015390:Gastric Bypass / Q000379:methods; D006801:Humans; D007583:Jejunum / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D016717:Sphincterotomy, Endoscopic / Q000379:methods*; D013270:Stomach / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome