# Laparoscopic common bile duct exploration for retained biliary stent removal after one anastomosis gastric bypass: A case report

## TL;DR

This case report describes a safe laparoscopic method to remove a retained bile duct stent in a patient who had weight-loss surgery.

## Contribution

The paper presents a novel laparoscopic approach for stent removal in patients with altered anatomy after bariatric surgery.

## Key findings

- Laparoscopic CBD exploration successfully removed a retained stent in a post-OAGB patient.
- Standard endoscopic access is often infeasible after OAGB due to altered anatomy.
- Tailored strategies are needed for managing biliary complications after metabolic and bariatric surgery.

## Abstract

Cholelithiasis is common following metabolic and bariatric surgery (MBS), with gallstones developing in up to one-third of patients due to rapid weight loss and metabolic changes. Procedures such as Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) alter gastrointestinal anatomy, complicating endoscopic access to the biliary tree and presenting challenges in the management of choledocholithiasis. This report highlights the relationship between MBS and biliary complications, using a case of post-OAGB cholangitis due to a retained stent to illustrate broader management considerations.

A 50-year-old female with a history of vertical banded gastroplasty, laparoscopic cholecystectomy, and prior ERCP with CBD stent placement for choledocholithiasis underwent OAGB. One month postoperatively, she had abdominal pain and fever. An abdominal CT scan showed a retained stent in the CBD. Due to altered anatomy after OAGB, standard endoscopic stent retrieval was not feasible. She underwent laparoscopic CBD exploration with intraoperative ultrasound to identify the retained stent. A longitudinal choledochotomy was performed, the stent and stone debris were removed, and the choledochotomy was closed primarily. Her postoperative course was uneventful.

In patients after OAGB, standard biliary access is not feasible, and alternative approaches are required. Laparoscopic CBD exploration is one option that was shown to be effective in this case.

This case highlights the challenge of managing biliary disease in post-MBS patients. A detailed history and file review help prevent stent retention. Laparoscopic CBD exploration offers a safe and effective solution when conventional endoscopic access is limited.

•Management of choledocholithiasis in patients with altered anatomy require a tailored strategy•Retained stents could be encountered in patients after metabolic and bariatric surgery•In this case, laparoscopic common bile duct exploration with stent removal was safe and effective

Management of choledocholithiasis in patients with altered anatomy require a tailored strategy

Retained stents could be encountered in patients after metabolic and bariatric surgery

In this case, laparoscopic common bile duct exploration with stent removal was safe and effective