Laparoscopic Transcystic Common Bile Duct Exploration for the Treatment of Choledocholithiasis Following Roux-en-Y Gastric Bypass.

INTRODUCTION

Choledocholithiasis is challenging to treat in patients who have undergone Roux-en-Y gastric bypass (RYGB). Laparoscopic transcystic common bile duct exploration (LTCBDE) performed at the time of the cholecystectomy is an alternative treatment modality that has the potential to reduce hospital length of stay (LOS) and postoperative morbidity.

METHODS

This is an IRB-approved, single-academic institution retrospective cohort study analyzing electronic medical records of patients with RYGB anatomy who underwent LTCBDE for choledocholithiasis between 2021 and 2025. The primary outcome of interest was procedural response. Secondary outcomes of interest included technical response rates, operative and 30-day postoperative complications. Hospital and postoperative LOS were compared between admitting services.

RESULTS

Nineteen patients with RYGB anatomy underwent LTCBDE and concomitant cholecystectomy. Technical response was achieved in 100% of patients, and procedural response was achieved in 94.7% of patients. One (5.3%) required an additional procedure after a retained stone was found incidentally on cross-sectional imaging for oncologic surveillance purposes. No intraoperative or postoperative complications were experienced. Patients admitted to a surgical service had a shorter hospital LOS by 3.1 days on average (P < 0.001; 95% CI -1.2,-2.6) and median postoperative LOS by 0.3 days (P = 0.035; 95% CI -0.1,-1.6) than those admitted to a medicine service.

CONCLUSIONS

Our data demonstrate high rates of technical and procedural response with no complications, and a shorter overall hospital LOS when managed by a surgical team, supporting the use of LTCBDE to treat choledocholithiasis in patients with RYGB anatomy.