Access to the gastric remnant and duodenum is lost after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Traditionally, a percutaneous transhepatic access to the common bile duct has been used to manage choledocholithiasis and duct strictures. We present a novel method of laparoscopic transgastric endoscopic retrograde cholangiopancreatography for managing a benign biliary stricture after a Roux-en-Y gastric bypass.

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Gastrotomy with anvil dunk is a reproducible and safe method for constructing the gastrojejunostomy. It is an advanced laparoscopic technique that closely resembles open surgical techniques and provides a safe alternative to existing methods.