Elective laparoscopic cholecystectomy in the presence of common bile duct stent

Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure done in patients with common bile duct (CBD) stones. Some clinicians insert a CBD stent at the time of ERCP. Such patients may then present for laparoscopic cholecystectomy (LC) with CBD stents in situ. The aim of this study was to examine the impact of the presence of a CBD stent on the outcome of elective LC.

This was a case-controlled study conducted from January 2005 to June 2008. The patients were divided into three comparable groups: group 1, those having LC preceded by ERCP; group 2, those having LC preceded by ERCP and stent insertion; and group 3, those having LC alone.

Four hundred one LC procedures were performed, five of which were excluded (two had had previous upper abdominal surgery, two had isolated pancreatic stents, and one had the stent removed the day before surgery). Of the 396 patients studied, there were 31 patients in group 1, 35 patients in group 2, and 330 patients in group 3. The incidence of conversion, postoperative bile leak, operating time, and length of stay was significantly higher in Group 2 (p<0.05). The incidence of conversion increased with the duration of in-situ stent placement (Spearman correlation coefficient=0.34, p<0.05). There was one case of abandoned cholecystectomy, two cases of CBD erosion, one case of CBD injury, and two cases of in-hospital mortality, all involving patients in group 2 only.

We conclude that LC in the presence of CBD stents poses significant risk to patients, particularly if they are left in-situ for long periods of time. Caution should be exercised in stenting a CBD with an intact gallbladder, particularly in those awaiting cholecystectomy.