Laparoscopic antegrade biliary stenting for postoperative endoscopic clearance of biliary stones

Unsuspected ductal stones discovered during laparoscopic cholecystectomy ma y necessitate conversion to an open procedure, laparoscopic extraction, or postoperative endoscopic papillotomy. In order not to lose the advantages o f a minimally invasive treatment and to decrease the likelihood of postoper ative endoscopic failure, laparoscopic antegrade biliary stenting was attem pted in 10 unselected patients (8 women, 2 men; mean age 52 +/- 11.4 years) with intraoperatively detected common bile duct stones. The mean diameter of these stones was 7 mm (range 5-11 mm). One stenting failed because of st one impaction, but the procedure was successful with effective biliary drai nage in nine patients. The mean operative time was 70 (range 50-165) minute s. Subsequent ERCP was performed a mean of 8 (range 6-20) days after surger y. Deep cannulation, stent-guided papillotomy, and duct clearance was achie ved in all stented patients, without any complication. Laparoscopic antegra de biliary stenting provides a guide for subsequent endoscopic stone remova l, minimizing the risks of either stent migration or endoscopic failure. Th is combined technique is safe and cost effective and may be considered when ductal stones are discovered unexpectedly during laparoscopic cholecystect omy.