International Surgery Journal | December 2021 | Vol 8 | Issue 12 Page 3749 International Surgery Journal Alzahrani KM et al. Int Surg J. 2021 Dec;8(12):3749-3754 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Review Article Current management of choledocholithiasis after bariatric surgery Khalid M. Alzahrani 1 *, Sumayyah A. Jafri 2 , Hafiz A. Hamdi 3 INTRODUCTION Obesity is a rising epidemic with 39% of adults aged 18 years and over were overweight and 13% were obese per the most recent WHO global health observatory data, collated in 2016. 1 Obesity itself is factor for development of gallstone disease. However, bariatric surgery and also the subsequent weight loss, is associated with an increased risk for development of gallstone formation. 2 The overall postoperative incidence of cholelithiasis ranging from 6.53%-52.8%. 2-7 Around 25% of patients carrying gallstones develop complications, like cholecystitis, cholangitis, or pancreatitis with annual risk for biliary colic in patients with asymptomatic gallstones has been estimated about 1%. Common bile duct stones prevalence ranging from 4.6% to 12% in Europe, and up to 20.9% in South America in patients with symptomatic gallbladder stones. 8-12 There are various bariatric procedures including restrictive, malabsorptive and mixed mechanisms to reduce body weight. The restrictive bariatric procedures are gastric banding and sleeve gastrectomy. The anatomy is merely slightly modified from the perspective of endoscopic papillary access in the restrictive bariatric procedures, this enables an easy approach of the biliary ducts and enable a transoral route for ERCP. 13 ABSTRACT The increasing prevalence of obesity all over world has led to a growing number of metabolic and bariatric surgeries. Bariatric surgery is more effective for weight loss than medical therapy, with Roux-en-Y gastric bypass (RYGB) being considered the gold standard of care over the past decade. Bariatric surgery and the subsequent weight loss are associated with an increased risk for the development of gallstone formation. Common bile duct stones prevalence around 10% among patients with symptomatic gallbladder stones. Choledocholithiasis can be technically challenging problem to treat in patients post-laparoscopic RYGB (LRYGB) or a biliopancreatic diversion (BPD/DS) due to the altered upper gastrointestinal anatomy. This review describes the different treatment options of common bile duct stones after malabsorptive bariatric surgery, success rate, and adverse effects of each treatment modality including enteroscopy-assisted endoscopic retrograde cholangiopancreatography (EA-ERCP), percutaneous transhepatic cholangiography (PTC), endoscopic ultrasound-directed transgastric retrograde cholangiopancreatography (EDGE), and laparoscopic-assisted ERCP (LAERCP). Keywords: Choledocholithiasis, Bariatric surgery, EA ERCP, LA-ERCP, EDGE Department of Surgery, 1 Taif University, College of Medicine, Taif, Saudi Arabia, 2 Al Hada Armed Forces Hospital, Taif, Saudi Arabia, 3 King Abdul-Aziz Specialist Hospital, Taif, Saudi Arabia Received: 25 October 2021 Revised: 17 November 2021 Accepted: 19 November 2021 *Correspondence: Dr. Khalid M. Alzahrani, E-mail: dr.k.al_zahrani@tu.edu.sa Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2349-2902.isj20214781