Different Approaches to Management of Common Duct Stone (CBDS) in Patients who Had Roux-En-Y Gastric Bypass (RYGB)

Abstract

Introduction: Symptomatic CBDS are commonly diagnosed in obese patients after Roux-en-Y gastric bypass RYGB. Management can be challenging due to the altered gastrointestinal anatomy. Various techniques are available, we present a cohort of patients who were safely managed with three different approaches to remove CBD stones. Method: A retrospective chart review of patients who had symptomatic CBDS after RYGB underwent: Percutaneous trans-hepatic CBDS removal, Laparoscopic assisted trans-gastric/ ERCP, Robotic CBD exploration & choleducho-duodenostomy/choleducho-jejunostomy. Results: From April,2011 to June,2019 a total of 25 patients (93.3% Caucasian; 70% female; age ranges from 38-90 years) were successfully managed with PTC, balloon sphincteroplasty and stone forced down to the duodenum (#18). Laparoscopic trans gastric ERCP (#4) and Robotic CBD exploration & CBD bypass & cholecystectomy (#3). There were four complications, two hemobilia, one bile leak and one enterotomy and no mortality. Conclusion: We have presented three different safe approaches to manage CBD stones in patients with gastric bypass with low morbidity and no mortality.