Skip to main content
SpringerLink
Log in

Temporary Restoration of Digestive Continuity After Laparoscopic Gastric Bypass to Allow Endoscopic Sphincterotomy and Retrograde Exploration of the Biliary Tract

  • Case Report
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

The prevalence of morbid obesity is rapidly increasing worldwide. As surgery has been recognized to be the only effective treatment for morbid obesity, the number of bariatric procedure realized each year has dramatically increased. Among all the surgical options, gastric bypass in considered as the gold standard. A possible drawback of this operation is the difficult access to the excluded proximal intestinal tract and, consequently, to the biliary tract. As gallstone formation may be frequent after a rapid weight loss induced by surgery, surgeons could be frequently asked to face the need of exploration of the biliary tree after anatomical changes induced by this kind of surgery. Many technical solutions, mainly based on a combined laparoscopic and endoscopic approach, have been proposed by several authors to face this problem. We herein describe an original technique to allow endoscopic exploration of biliary tract after a laparoscopic gastric bypass based on temporary restoration of physiological digestive continuity followed by re-establishment of the Roux-en-Y loop.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.

    Article  PubMed  Google Scholar 

  2. Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA. 2003;289(2):187–93.

    Article  PubMed  Google Scholar 

  3. Papasavas PK, Caushaj PF, McCormick JT, et al. Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity. Surg Endosc. 2003;17(4):610–4.

    Article  CAS  PubMed  Google Scholar 

  4. Steinbrook R. Surgery for severe obesity. N Engl J Med. 2004;350(11):1075–9.

    Article  CAS  PubMed  Google Scholar 

  5. DeMaria EJ. Is gastric bypass superior for the surgical treatment of obesity compared with malabsorptive procedures? J Gastrointest Surg. 2004;8(4):401–3.

    Article  PubMed  Google Scholar 

  6. Iannelli A, Facchiano E, Gugenheim J. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg. 2006;16(10):1265–71.

    Article  PubMed  Google Scholar 

  7. Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232(4):515–29.

    Article  CAS  PubMed  Google Scholar 

  8. Fobi MA, Chicola K, Lee H. Access to the bypassed stomach after gastric bypass. Obes Surg. 1998;8(3):289–95.

    Article  CAS  PubMed  Google Scholar 

  9. Martinez J, Guerrero L, Byers P, et al. Endoscopic retrograde cholangiopancreatography and gastroduodenoscopy after Roux-en-Y gastric bypass. Surg Endosc. 2006;20(10):1548–50.

    Article  CAS  PubMed  Google Scholar 

  10. Nguyen NT, Hinojosa MW, Slone J, et al. Laparoscopic transgastric access to the biliary tree after Roux-en-Y gastric bypass. Obes Surg. 2007;17(3):416–9.

    Article  PubMed  Google Scholar 

  11. Patel JA, Patel NA, Shinde T, et al. Endoscopic retrograde cholangiopancreatography after laparoscopic Roux-en-Y gastric bypass: a case series and review of the literature. Am Surg. 2008;74(8):689–93. discussion 693-4.

    PubMed  Google Scholar 

  12. IgleziasBrandaodeOliveira C, Adami Chaim E, da Silva BB. Impact of rapid weight reduction on risk of cholelithiasis after bariatric surgery. Obes Surg. 2003;13(4):625–8.

    Article  Google Scholar 

  13. Ceppa FA, Gagne DJ, Papasavas PK, Caushaj PF. Laparoscopic transgastric endoscopy after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3(1):21–4.

    Article  PubMed  Google Scholar 

  14. Nguyen NT, Root J, Zainabadi K, et al. Accelerated growth of bariatric surgery with the introduction of minimally invasive surgery. Arch Surg. 2005;140(12):1198–202. discussion 1203.

    Article  PubMed  Google Scholar 

  15. Peters M, Papasavas PK, Caushaj PF, et al. Laparoscopic transgastric endoscopic retrograde cholangiopancreatography for benign common bile duct stricture after Roux-en-Y gastric bypass. Surg Endosc. 2002;16(7):1106.

    Article  CAS  PubMed  Google Scholar 

  16. Sundbom M, Nyman R, Hedenstrom H, Gustavsson S. Investigation of the excluded stomach after Roux-en-Y gastric bypass. Obes Surg. 2001;11(1):25–7.

    Article  CAS  PubMed  Google Scholar 

  17. Wright BE, Cass OW, Freeman ML. ERCP in patients with long-limb Roux-en-Y gastrojejunostomy and intact papilla. Gastrointest Endosc. 2002;56(2):225–32.

    Article  PubMed  Google Scholar 

  18. Lonroth H, Dalenback J, Haglind E, Lundell L. Laparoscopic gastric bypass. Another option in bariatric surgery. Surg Endosc. 1996;10(6):636–8.

    Article  CAS  PubMed  Google Scholar 

  19. Msika S. Surgical treatment of morbid obesity by gastrojejunal bypass using laparoscopic roux-en-Y (gastric short circuit). J Chir (Paris). 2002;139(4):214–7.

    CAS  Google Scholar 

  20. Ahmed AR, Husain S, Saad N, et al. Accessing the common bile duct after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3(6):640–3.

    Article  PubMed  Google Scholar 

  21. Kita H, Yamamoto H. Double-balloon endoscopy for the diagnosis and treatment of small intestinal disease. Best Pract Res Clin Gastroenterol. 2006;20(1):179–94.

    Article  CAS  PubMed  Google Scholar 

  22. Moreels TG, Hubens GJ, Ysebaert DK, et al. Diagnostic and therapeutic double-balloon enteroscopy after small bowel Roux-en-Y reconstructive surgery. Digestion. 2009;80(3):141–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Louis Mourier Hospital, Assistance Publique–Hopitaux de Paris, University Denis Diderot Paris VII, 178, rue des Renouillers, Colombes, 92701, Paris, France

    Arnaud Saget, Enrico Facchiano, Pierre-Olivier Bosset, Benjamin Castel & Simon Msika

  2. Department of Gastroenterology, Beaujon Hospital, Assistance Publique–Hopitaux de Paris, University Denis Diderot Paris VII, Clichy, Paris, France

    Philippe Ruszniewski

Authors
  1. Arnaud Saget
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Enrico Facchiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pierre-Olivier Bosset
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benjamin Castel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philippe Ruszniewski
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Simon Msika
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simon Msika.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saget, A., Facchiano, E., Bosset, PO. et al. Temporary Restoration of Digestive Continuity After Laparoscopic Gastric Bypass to Allow Endoscopic Sphincterotomy and Retrograde Exploration of the Biliary Tract. OBES SURG 20, 791–795 (2010). https://doi.org/10.1007/s11695-010-0115-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-010-0115-1

Keywords

Search

Navigation