Management of common bile duct stone late after laparoscopic Roux-en-Y gastric bypass for obesity

Rapid weight loss following Roux-en-Y gastric bypass (RYGBP) for the treatment of obesity can increase the incidence of cholelithiasis formation. Nevertheless, routine simultaneous cholecystectomy at the time of bariatric surgery remains controversial. However, in case of delayed occurrence of common bile duct (CBD) stones, the difficulty to reach endoscopically the biliary tract after RYGBP should be kept in mind. We here report the case of a patient who presented with CBD stones seven years after gastric banding followed five years later by RYGBP without associated cholecystectomy. Our approach of transgastric laparoscopic assisted endoscopic retrograde cholangiopancreaticography followed by sphincterotomy and balloon stones extraction is illustrated.