Biliary Stricture After a Roux-en-Y Gastric Bypass with Remnant Gastrectomy

Introduction: We report a case of benign biliary stricture in a 62-year-old woman after a laparoscopic Roux-en-Y gastric bypass with remnant gastrectomy as a result of morbid obesity and villous adenoma of the gastric antrum. Case Description: The patient’s clinical presentation was intermittent biliary-type pain. On admission, no remarkable physical findings were observed, but a dilated common bile duct was seen on a magnetic resonance cholangiography without the presence of stones or tumor masses. After a failed laparoscopic-assisted endoscopic papillotomy, the case was resolved by a laparoscopic choledocoduodenostomy. Discussion: The diagnosis and treatment of abdominal pain in patients with Roux-en-Y gastric bypass anatomy can be very demanding. Biliary stricture is an infrequent complication in these patients and although the combined approach (endoscopy-laparoscopy) is the initial therapeutic option, a bilioenteric bypass could be required if there are failures or relapses.