CASE REPORT Temporary Restoration of Digestive Continuity After Laparoscopic Gastric Bypass to Allow Endoscopic Sphincterotomy and Retrograde Exploration of the Biliary Tract Arnaud Saget & Enrico Facchiano & Pierre-Olivier Bosset & Benjamin Castel & Philippe Ruszniewski & Simon Msika Published online: 7 March 2010 # Springer Science+Business Media, LLC 2010 Abstract The prevalence of morbid obesity is rapidly increasing worldwide. As surgery has been recognized to be the only effective treatment for morbid obesity, the number of bariatric procedure realized each year has dramatically increased. Among all the surgical options, gastric bypass in considered as the gold standard. A possible drawback of this operation is the difficult access to the excluded proximal intestinal tract and, consequently, to the biliary tract. As gallstone formation may be frequent after a rapid weight loss induced by surgery, surgeons could be frequently asked to face the need of exploration of the biliary tree after anatomical changes induced by this kind of surgery. Many technical solutions, mainly based on a combined laparoscopic and endoscopic approach, have been proposed by several authors to face this problem. We herein describe an original technique to allow endo- scopic exploration of biliary tract after a laparoscopic gastric bypass based on temporary restoration of physio- logical digestive continuity followed by re-establishment of the Roux-en-Y loop. Keywords Laparoscopy . Obesity surgery . Sphincterotomy . Gastric bypass . Endoscopic retrograde cholangiopancreatography Introduction Obesity represents a major problem of public health in developed countries with a prevalence doubled in the USA from 1980 through 2004 [1]. As shown by several epidemiologic studies, obesity is associated with increased mortality with a life expectancy of severe obese persons reduced by five to 20 years [1, 2]. Bariatric surgery is considered as the only really effective treatment for morbid obesity since diet, exercise, and behavioral and pharmaceu- tical approach usually record a high failure rate [3]. As a consequence, the use of bariatric surgery has dramatically increased with more than 100,000 operations performed in the USA in 2003 [4]. Among all bariatric operations, gastric bypass has been shown to be really effective and is considered by several authors as a gold standard of bariatric surgery [5–7]. A possible major drawback of this operation is a difficult access to the excluded proximal intestinal tract and, consequently, to the biliary tract [8–11]. The rapid weight loss after bariatric surgery, in fact, represents a well- assessed risk factor for gallstones formation which can result in acute and potentially dangerous complications such as cholecystitis, choledocholithiasis, acute pancreatitis, and acute cholangitis [12]. As a matter of fact, the exploration of the biliary tract after laparoscopic gastric bypass (LGBP) represents a major challenge for surgeons and physicians and this problem will equally be found for A. Saget : E. Facchiano : P.-O. Bosset : B. Castel : S. Msika (*) Department of Surgery, Louis Mourier Hospital, Assistance Publique–Hopitaux de Paris, University Denis Diderot Paris VII, 178, rue des Renouillers, Colombes, 92701 Paris, France e-mail: simon.msika@lmr.aphp.fr P. Ruszniewski Department of Gastroenterology, Beaujon Hospital, Assistance Publique–Hopitaux de Paris, University Denis Diderot Paris VII, Clichy, Paris, France OBES SURG (2010) 20:791–795 DOI 10.1007/s11695-010-0115-1