Selective Antegrade Biliary Stenting Aids Emergency Laparoscopic Cholecystectomy

Area of Science:

• Gastroenterology
• Surgical Innovation
• Biliary Tract Disease

Background:

• Symptomatic gallstone disease necessitates prompt treatment to prevent complications.
• Diagnosis and management of concomitant choledocholithiasis often delay essential treatment.
• Preoperative endoscopic retrograde cholangiopancreatography (ERCP) carries risks and is frequently unnecessary.

Purpose of the Study:

• To present a technique for managing choledocholithiasis during cholecystectomy.
• To evaluate the outcomes of early cholecystectomy with selective antegrade stenting.
• To compare this strategy with preoperative ERCP for common bile duct stones.

Main Methods:

• A 3-year review of a prospectively maintained database (January 2014-January 2017).
• Routine intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC).
• Transcystic antegrade biliary stenting for encountered choledocholithiasis to decompress the common bile duct (CBD).

Main Results:

• Of 411 LCs, 74 patients had common bile duct stones (CBDS) identified on IOC.
• Antegrade stents were successfully placed in 69 cases, without increasing length of hospital stay or complication rates.
• Preoperative ERCP significantly increased length of hospital stay and complication rates, with 67% requiring multiple procedures.

Conclusions:

• Early cholecystectomy with selective antegrade stenting is a safe and effective strategy for managing choledocholithiasis.
• This approach simplifies treatment for general surgeons, avoiding specialist skills and unnecessary preoperative ERCP.
• The technique is beneficial for acute admissions, including pancreatitis cases with common bile duct stones.