In this article, we report a patient with a history of partial gastrectomy and Roux-en-Y reconstruction who presented with abdominal pain due to sphincter of Oddi dysfunction. After failed endoscopic retrograde cholangiopancreatography (ERCP) through the anatomic route, the procedure was successfully performed with laparoscopy assistance through an enterotomy into the biliopancreatic limb. An internal hernia was diagnosed incidentally and treated appropriately. Laparoscopy-assisted ERCP is a viable option in patients with Roux-en-Y anatomy, even when the gastric remnant and duodenum are not available. © Mary Ann Liebert, Inc.