SRS203 - Management of choledocholithiasis in patients with Roux-en-Y Gastric Bypass in a tertiary bariatric centre

Abstract Aims Patients with Roux-en-Y Gastric Bypass (RYGB) have altered anatomy, making traditional Endoscopic Retrograde Cholangiopancreatography (ERCP) unfeasible for managing common bile duct (CBD) stones. This study reports first-year outcomes of establishing a laparoscopic CBD-stone service in a Tertiery London bariatric centre performing ∼300 RYGB procedures annually. Methods A prospective cohort study was conducted from June 2024 to June 2025 in a tertiary bariatric centre. All post-RYGB patients undergoing laparoscopic cholecystectomy (LC) and laparoscopic CBD exploration (LCBDE) by a single surgeon were included. Eleven elective cases were analysed. Patient characteristics and outcomes were assessed. Results Mean age was 60 (Female: Male = 10:1), and mean pre-op BMI was 32.4. Average post-op stay was 3 days; 3 patients were day cases, and 2 had planned overnight stays. Two patients with biliary colic underwent routine LC. Nine patients had pre-operative evidence of CBD stones or dilated ducts. Of these, two underwent intraoperative cholangiogram (IOC) confirming no stones and had LC only. The remaining seven underwent transcystic LCBDE using a 3mm SpyGlass (Boston Scientific) scope, with 100% successful stone clearance. There were no intraoperative complications and minimal post-operative morbidity. Conclusions LCBDE is a feasible and safe option in post-RYGB patients and should be considered in high-volume bariatric centres, where gallstone disease is a common long-term outcome of rapid weight loss. Patients with pancreatitis or poor nutritional status require careful selection. Trans-gastric ERCP should be reserved as a second-line option when LCBDE fails or is not feasible.