Background: Obesity is reaching epidemic proportions in the United States and worldwide. Roux-en-y gastric bypass is most common bariatric surgical procedure performed. We propose a minimally invasive technique which is easily duplicated to gain access to the gastric remnant and the biliary tree.
Method: Report of two cases with suspicion of choledocholithiasis and history of roux-en-Y bypass. Under direct visualization and with two stay sutures at 3 and 9 o-clock a bladed 15 mm trocar inserted into the remnant. New sterile drape placed to include only the 15mm trocar. Through the 15mm trocar an ERCP scope easily passed and ampulla identified and cannulated. Successful stone retrieval and papillotomy performed. We then were able to close the gastrotomy with linear endo-GIA stapler. Case two required small incision and bringing the stomach through the fascia, gastrotomy performed with two layers of pursestrings and 15mm trocar inserted. Gastrotomy was the closed in a two layer hand sewn fashion.
Conclusion: The population of gastric bypass patients is increasing. This technique is easily duplicated and performed in private community hospitals where experienced laparoscopists and endoscopists are available.
Program Number: P030