Abstracts
2000 Digestive Disease Week

# 2220 Laparoscopic Endobiliary Stenting: A Simplified Approach to the Management of Occult Common Bile Duct Stones.
Robert D. Fanelli, Keith S. Gersin, Pittsfield, MA

Background: Three years ago we described laparoscopic placement of biliary stents as an adjunct to laparoscopic common bile duct exploration (LCBDE) for treatment of occult common bile duct stones (CBDS) (Surgical Endoscopy vol. 12(4), April 1998 p. 301-304). LCBDE was performed to clear all CBDS prior to stent placement in 16 patients by either choledochotomy or transcystic methods. We now present a modification of our technique and our experience with 48 additional patients. Methods: All patients presenting for elective cholecystectomy were treated using a standard 4-port laparoscopic approach. Routine intraoperative fluorocholangiography revealed occult CBDS in 48 patients during 36 months. In our initial series, stents were placed for biliary decompression, to protect the ductal closure, and guard against the complications associated with retained CBDS. Closed suction drains were used routinely and all patients were admitted for 24 to 48 hours following surgery. In our current series, we made no attempt to clear CBDS prior to stent placement. All stents were placed transcystically, and external drains were not employed. Results: Stent placement added 9 to 26 minutes to operative time over laparoscopic cholecystectomy alone. Forty-four patients (92%) were discharged the day of surgery, and 4 patients (8%) were observed overnight. Outpatient ERCP 1 to 4 weeks after surgery was successful in clearing CBDS in all patients. Stents were retrieved without difficulty in all cases, and 3 to 36-month follow up demonstrates no surgical, endoscopic, or stent related complications to date. Conclusion: Laparoscopic biliary stent placement for the treatment of CBDS is a safe, rapid, technically less challenging alternative to existing methods of LCBDE. It preserves the benefits of minimally invasive surgery for patients, and provides all surgeons with a less difficult, highly successful method for treating occult CBDS. Stent placement virtually assures success of postoperative ERCP with complete stone clearance. Surgeons will develop expertise in this procedure rapidly, once all-inclusive laparoscopic biliary stent kits become commercially available.