title: A laparoscopic transgastric approach to the treatment of sphincter of Oddi dysfunction postgastric bypass.
abstract: Obesity is endemic and bariatric surgery is increasing in an attempt to reduce the physiological and social cost. As the prevalence of bariatric surgery increases, in particular laparoscopic roux-en-Y gastric bypass (LRYGB), the need to investigate and treat subsequent pathology in the gastric remnant and biliary tree will accrue. We describe a novel combined surgical and endoscopic technique addressing the challenges of postoperative anatomy, allowing investigation and treatment of the gastric remnant and biliary tract. We present the case of a patient with sphincter of Oddi dysfunction post-LRYGB who underwent laparoscopic transgastric endoscopic injection of Botox into the ampulla with an excellent symptomatic relief. Subsequent laparoscopic transgastric sphincterotomy allowed definitive treatment and allowed symptom resolution at 6 months follow-up. Laparoscopic transgastric endoscopic investigation and treatment is a novel approach to circumvent the restrictions of post-LRYGB anatomy and may assume greater importance in an ageing obese population.
authors.affiliation: Department of Upper GI Surgery, Bradford Royal Infirmary, Bradford, UK. kdickinson0@hotmail.com
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Dickinson
authors.forename: Conrad G
authors.initials: CG
authors.lastname: Beckett
authors.forename: John C
authors.initials: JC
authors.lastname: May
authors.forename: James C
authors.initials: JC
authors.lastname: Halstead
mesh_terms: D000328:Adult; D001659:Biliary Tract / Q000473:pathology*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D018530:Gastric Stump / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D009765:Obesity / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D046628:Sphincter of Oddi Dysfunction / Q000209:etiology / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic