title: Management of biliary symptoms after bariatric surgery.
abstract: BACKGROUND
  Biliary disease requiring intervention can be complicated in the postbariatric surgery patient.
  
  
  METHODS
  A retrospective review was completed to identify patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy from September 2001 to September 2014, and those who underwent biliary intervention were identified.
  
  
  RESULTS
  A total of 1527 patients underwent bariatric surgery during the study period. Of the 1,112 patients without prior cholecystectomy, 91 (8%) had biliary symptoms requiring intervention. Ninety patients underwent cholecystectomy, with 86 successfully completed laparoscopically. Six patients required laparoscopy-assisted percutaneous transgastric endoscopic retrograde cholangiopancreatography along with cholecystectomy to clear gallstones from the common bile duct. Three patients who had undergone cholecystectomy before bariatric surgery developed primary common bile duct stones.
  
  
  CONCLUSIONS
  Surgery for biliary disease after bariatric surgery can be completed successfully with minimal complications, and percutaneous transgastric endoscopic retrograde cholangiopancreatography has a high success rate of access to and clearance of the biliary tree.
authors.affiliation: Minimally Invasive Bariatric Surgery and Advanced Laparoscopy Fellowship, Department of Medical Education, Gundersen Medical Foundation, La Crosse, WI, USA.
authors.forename: Joel R
authors.initials: JR
authors.lastname: Brockmeyer
authors.affiliation: Department of General and Vascular Surgery, Gundersen Health System, 1900 South Avenue, C05-001, La Crosse, WI 54601, USA.
authors.forename: Brandon T
authors.initials: BT
authors.lastname: Grover
authors.affiliation: Department of Surgery Research, Gundersen Medical Foundation, La Crosse, WI, USA.
authors.forename: Kara J
authors.initials: KJ
authors.lastname: Kallies
authors.affiliation: Department of General and Vascular Surgery, Gundersen Health System, 1900 South Avenue, C05-001, La Crosse, WI 54601, USA. Electronic address: snkothar@gundersenhealth.org.
authors.forename: Shanu N
authors.initials: SN
authors.lastname: Kothari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D003135:Common Bile Duct / Q000601:surgery; D005260:Female; D042882:Gallstones / Q000601:surgery*; D005743:Gastrectomy; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bariatric surgery; Biliary system; Cholelithiasis; Endoscopic retrograde cholangiopancreatography