Role of Trans-Cystic Stenting in Management of Choledocholithiasis During Cholecystectomy

Choledocholithiasis detected during laparoscopic cholecystectomy is common. There is no consensus for the best management in this context. Trans-cystic biliary stent insertion is a well described but less commonly used method for managing choledocholithiasis with the gallbladder in situ.

Retrospective study including all patients undergoing trans-cystic biliary stenting followed by ERCP at Box Hill Hospital, from 2021 to 2024. Outcomes compared to control cohort of native ERCP for choledocholithiasis at the same institution. The primary outcome was post-ERCP pancreatitis.

Trans-cystic stenting was attempted in 49 patients. 45 (92%) were successful. The median age was 52 years, 73.4% were female, and 67% admitted emergently. No episodes of post-ERCP pancreatitis occurred when the trans-cystic stent was in position at ERCP, compared with 5% in the control cohort. Biliary cannulation rate was 97% if a stent was present, compared with 91% in the control cohort. 20% of stents had migrated by the time of ERCP. One patient developed pancreatitis post failed trans-cystic stent attempt. No other complications were recorded. The median length of stay (LOS) was 5.0 days. A 40% of patients were discharged prior to ERCP, resulting in a shorter median LOS: 4.0 versus 6.0 days (p = 0.014). No statistical differences were detected between variables for unsuccessful stenting, stent mis-deployment, or stent migration.

Trans-cystic stenting resulted in a low rate of post-ERCP pancreatitis and a high rate of biliary cannulation. It can be safely implemented by general surgeons and may result in a reduced length of stay.