LAPAROSCOPIC ENDOBILIARY STENTING AS AN ADJUNCT TO COMMON BILE-DUCT EXPLORATION

Background: The management of common bile duct stones (CBDS) in the er a of operative laparoscopy is evolving. Several minimally invasive tec hniques to remove CBDS have been described, including preoperative end oscopic retrograde cholangiopancreatography (ERCP), postoperative ERCP , Lithotripsy, laparoscopic transcystic common bile duct exploration, and laparoscopic choledochotomy with common bile duct exploration (CED E). Because of the risks and limitations of these procedures, we utili ze laparoscopi cally placed endobiliary stents as an adjunct to CEDE. Methods: Sixteen patients underwent laparoscopic common bile duct expl oration (LCBDE) by either choledochotomy or the transcystic technique with placement of endobiliary stents. These patients were identified d uring laparoscopic cholecystectomy as having occult choledocholithiasi s, using routine dynamic intraoperative cholangiography. Results: CBDS were successfully removed in all patients as demonstrated by completi on cholangiography and intraoperative choledochoscopy. Eighty percent of patients were discharged the following day; the first three patient s in this series were observed for 48 h prior to discharge. No patient required T-tube placement and closed suction drains were removed the morning after surgery. Stents were removed endoscopically at 1 month. Six-to 30-month follow-up demonstrates no complications to date. Concl usions: Laparoscopic endobiliary stenting reduces operative morbidity, eliminates the complications of T-tubes, and allows patients to retur n to unrestricted activity quickly. We recommend laparoscopically plac ed endobiliary stents in patients undergoing LCBDE.