Laparoscopic endobiliary stenting: A simplified approach to the managementof occult common bile duct stones

Three years ago we described laparoscopic placement of biliary stents as an adjunct to laparoscopic common bile duct exploration (LCBDE) in 16 patient s. We now present a modification of our technique and experience with 48 ad ditional patients. Laparoscopic cholecystectomy with intraoperative fluoroc holangiography (LC/IOC) performed in 372 consecutive patients during a 36-m onth period revealed common bile duct stones (CBDS) in 48 patients (12.9%). in this series, LCBDE was not performed and no attempt was made to clear C BDS prior to transcystic stent placement. Stent placement added 9 to 26, mi nutes of operative time to LC/IOC alone. Forty-four patients (92%) were dis charged after surgery and four (8%) were observed overnight. Outpatient end oscopic retrograde cholangiopancreatography 1 to 4 weeks later succeeded in clearing CBDS in all patients. All stents were retrieved without difficult ) and 3- to 36-month follow-up demonstrates no surgical, endoscopic, or ste nt-related complications to date. Laparoscopic biliary stent placement for the treatment of CBDS is a safe, rapid, technically less challenging altern ative to existing methods of LCBDE. It preserves the: benefits of minimally invasive surgery for patients, and virtually assures success of postoperat ive endoscopic retrograde cholangiopancreatography with complete stone clea rance.