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Choledocholithiasis following roux-en-Y gastric bypass is a challenging problem to manage due to the anatomic changes. This case represents a novel approach with collaboration between surgeons and gastroenterologists when dealing with this problem. The patient was taken to the operating room and a laparoscopic gastrotomy was performed, through which ERCP was then accomplished via the excluded gastric remnant. These cases will undoubtedly become more and more common as gastric bypass is done more often and the patients live longer with their altered anatomy.
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