Transjejunal Laparoscopic-Assisted ERCP: a Technique to Deal with Choledocholithiasis After Roux-En-Y Reconstruction

  • Giorgio Dalmonte Email author
  • Marina Valente
  • Simone Bosi
  • Alessandro Gnocchi
  • Federico Marchesi
Video Submission



In Roux-en-Y reconstructions, choledocholithiasis could represent a really challenging condition to treat which can be treated by a surgical-assisted ERCP. Only six cases of transjejunal laparoscopic-assisted ERCP (LAERCP) can be found in literature to date and no large series are present.


A young woman who had undergone a laparoscopic Roux-en-Y gastric bypass 2 years earlier came complaining recurrent abdominal pain. Radiologic exams found stones in the common bile duct and no signs of internal hernia. We therefore decided to perform a transjejunal LAERCP finding a concomitant internal hernia in the Petersen’s space which was repaired at the same time.


The post-operative course was uneventful.


Transjejunal LAERCP is a feasible technique to deal with choledocholithiasis, and it allows at the same time to identify and treat concomitant conditions like internal hernias.


Transjejunal Laparoscopy ERCP Roux-En-Y Gastric bypass Choledocholithiasis Video Surgical technique 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from the participant.

Statement of Human Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material


(MP4 486,803 kb)


  1. 1.
    Jun K-H, Kim J-H, Kim J-J, et al. Retrospective analysis on the gallstone disease after gastrectomy for gastric cancer. Gastroenterol Res Pract Hindawi. 2015;2015:827864–7.CrossRefGoogle Scholar
  2. 2.
    Brockmeyer JR, Grover BT, Kallies KJ, et al. Management of biliary symptoms after bariatric surgery. Am J Surg. 2015;210:1010–6. discussion1016–7CrossRefGoogle Scholar
  3. 3.
    De Koning M, Moreels TG. Comparison of double-balloon and single-balloon enteroscope for therapeutic endoscopic retrograde cholangiography after Roux-en-Y small bowel surgery. BMC Gastroenterol BioMed Central. 2016;16:98.CrossRefGoogle Scholar
  4. 4.
    Aiolfi A, Asti E, Rausa E, et al. Trans-gastric ERCP after Roux-en-Y gastric bypass: systematic review and meta-analysis. Obes Surg Springer US. 2018;28:2836–43.CrossRefGoogle Scholar
  5. 5.
    Mutignani M, Marchese M, Tringali A, et al. Laparoscopy-assisted ERCP after biliopancreatic diversion. Obes Surg Springer-Verlag. 2007;17:251–4.CrossRefGoogle Scholar
  6. 6.
    Saleem A, Sawyer MD, Baron TH. Laparoscopy assisted transjejunal ERCP for treatment of pancreaticopleural fistula. JOP. 2010;11:69–71.Google Scholar
  7. 7.
    Lopes TL, Clements RH, Wilcox CM. Laparoscopy-assisted transjejunal ERCP in a patient with Roux-en-Y reconstruction following partial gastrectomy. J Laparoendosc Adv Surg Tech A. 2010;20:55–8.CrossRefGoogle Scholar
  8. 8.
    Mansor S, Abdalla S, Bendardaf R. Laparoscopy assisted transjejunal endoscopic retrograde cholangiography for treatment of intrahepatic duct stones in a post Roux-en-Y patient. Saudi Med J. 2015;36:104–7.CrossRefGoogle Scholar
  9. 9.
    Surdeanu IR, Moussaoui El I, Dika M, et al. Laparoscopy-assisted transjejunal ERCP in a patient with roux-en-Y gastric bypass. Acta Chir Belg. 2016:1–7.Google Scholar
  10. 10.
    Mita MT, Dalmonte G, Gnocchi A, et al. Transjejunal laparoscopic-assisted ERCP in Roux-en-Y patient: the new right path. Ann R Coll Surg Engl. 2018:e1–3.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Unit of Clinical Surgery, Department of Medicine and SurgeryParma University HospitalParmaItaly
  2. 2.S.C. Gastroenterologia ed Endoscopia DigestivaParma University HospitalParmaItaly

Personalised recommendations