Laparoscopic Common Bile Duct Exploration for Common Bile Duct Stones Complicated with Cholangitis in Patients with Roux-en-Y Gastric Bypass—Clinical Experience from Three Cases

Excerpt

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common elective bariatric surgery performed for morbid obesity. Due to a rapid weight loss after LRYGB, these patients have a high risk of common bile duct stones (CBDS) [1]. The CBDS course may be complicated by cholangitis. Gold standard treatment for CBDS is endoscopic retrograde cholangio-pancreaticography (ERCP) with stone extraction and subsequent laparoscopic cholecystectomy as a two-stage procedure [2]. Due to the alternated anatomy after LRYGB, stone extraction through conventional ERCP cannot be performed and alternative techniques may include percutaneous transhepatic biliary drainage (PTCD), percutaneous or laparoscopic transgastric ERCP (LTG-ERCP), and transenteric ERCP [3]. A number of studies report successful treatment with laparoscopic common bile duct exploration (LCBDE) and cholecystectomy (LC) performed as a single-stage procedure in patients with CBDS and with native anatomy [4]. To our knowledge, no experiences of LCBDE + LC in RYGB patients with CBDS complicated by cholangitis have been reported yet. …