Laparoscopic transgastric access to the biliary tree after Roux-en-Y gastric bypass

Gallstone disease, common after Roux-en-Y gastric bypass (RYGBP), may be complicated by biliary duct obstruction and gallstone pancreatitis. Although endoscopic retrograde cholangiopancreatography plays an important role in management of biliary duct obstruction, the altered anatomy of patients who have had a RYGBP makes this procedure technically difficult. With the increased number of patients undergoing RYGBP for morbid obesity, bariatric surgeons may benefit from an alternative laparoscopic technique for accessing the biliary tree. We describe a laparoscopic technique of accessing the biliary tree through the bypassed stomach.