Biliary Stricture After a Roux-en-Y Gastric Bypass with Remnant Gastrectomy

Salvador Navarrete Llopis, MD, Igor Bello, MD, José Luis Leyba, MD, Gabriel Escalona, MD, Cono Gumina

Department of General Surgery, Hospital Universitario de Caracas, Venezuela (Drs. Llopis, Escalona). Department of General Surgery, Universidad de Carabobo, Naguanagua, Venezuela (Dr. Bello). Department of General Surgery, Universidad Central de Venezuela, Caracas, Venezuela (Dr. Leyba). Department of Gastroenterology, Clínica Santa Sofía, Caracas, Venezuela (Dr. Gumina).

ABSTRACT

Introduction: We report a case of benign biliary stricture in a 62-year-old woman after a laparoscopic Roux-en-Y gastric bypass with remnant gastrectomy as a result of morbid obesity and villous adenoma of the gastric antrum.Case Description: The patient’s clinical presentation was intermittent biliary-type pain. On admission, no remarkable physical findings were observed, but a dilated common bile duct was seen on a magnetic resonance cholangiography without the presence of stones or tumor masses. After a failed laparoscopic-assisted endoscopic papillotomy, the case was resolved by a laparoscopic choledocoduodenostomy.Discussion: The diagnosis and treatment of abdominal pain in patients with Roux-en-Y gastric bypass anatomy can be very demanding. Biliary stricture is an infrequent complication in these patients and although the combined approach (endoscopy-laparoscopy) is the initial therapeutic option, a bilioenteric bypass could be required if there are failures or relapses.

Key Words: Roux-en-Y gastric bypass, Biliary stricture, Laparoscopy.

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