UNSUSPECTED CHOLEDOCHOLITHIASIS FIRST DIAGNOSED AT LAPAROSCOPIC CHOLECYSTECTOMY - TREATMENT BY TRANS-CYSTIC DUCT STENTING AND ELECTIVE STENT-GUIDED SPHINCTEROTOMY

Background: Despite advances in laparoscopic surgery, management of un suspected choledocholithiasis diagnosed at laparoscopic cholecystectom y is controversial. We propose a simple maneuver of laparoscopic trans -cystic duct stenting of the papilla during cholecystectomy, followed by elective stent-guided sphincterotomy, as an expedient option. Metho ds: We studied retrospectively 16 patients with choledocholithiasis fi rst diagnosed in the course of laparoscopic cholecystectomy, treated w ith laparoscopic stenting of the papilla via the cystic duct using a s hort Cotton-Leung stent before completion of cholecystectomy. Elective stent-guided, needle-knife sphincterotomy and stone clearance was per formed 2 to 3 weeks postoperatively. Results: Of 16 patients attempted , the procedure failed in one due to an impacted stone that prevented passage of the guidewire, Stenting time was 13 +/- 5 minutes (n = 15). Two stented patients had no stones at endoscopic retrograde cholangio graphy. Thirteen patients had successful elective stent-guided sphinct erotomy with stone clearance without complications. Conclusions: Lapar oscopic biliary stenting combined with stent-guided sphincterotomy is a simple, safe, and cost-effective option for the management of uncomp licated choledocholithiasis.