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

INTRODUCTION

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.

CASE PRESENTATION

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.

DISCUSSION

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.

CONCLUSION

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.