Unsuspected choledocholithiasis first diagnosed at laparoscopic cholecystectomy: treatment by trans-cystic duct stenting and elective stent-guided sphincterotomy - 09/09/11
Abstract |
Background: Despite advances in laparoscopic surgery, management of unsuspected choledocholithiasis diagnosed at laparoscopic cholecystectomy is controversial. We propose a simple maneuver of laparoscopic trans-cystic duct stenting of the papilla during cholecystectomy, followed by elective stent-guided sphincterotomy, as an expedient option. Methods: We studied retrospectively 16 patients with choledocholithiasis first diagnosed in the course of laparoscopic cholecystectomy, treated with laparoscopic stenting of the papilla via the cystic duct using a short Cotton-Leung stent before completion of cholecystectomy. Elective stent-guided, needle-knife sphincterotomy and stone clearance was performed 2 to 3 weeks postoperatively. Results: Of 16 patients attempted, the procedure failed in one due to an impacted stone that prevented passage of the guidewire. Stenting time was 13 ± 5 minutes (n = 15). Two stented patients had no stones at endoscopic retrograde cholangiography. Thirteen patients had successful elective stent-guided sphincterotomy with stone clearance without complications. Conclusions: Laparoscopic biliary stenting combined with stent-guided sphincterotomy is a simple, safe, and cost-effective option for the management of uncomplicated choledocholithiasis.
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| From the Departments of Surgery, Meridia Huron and Hillcrest Hospitals, Cleveland, Ohio. |
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| Supported by Departmental Research Funds. |
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| Reprint requests: R. S. Chung, MD, Department of Surgery, Meridia Huron Hospital, 13951 Terrace Rd., Cleveland, OH 44112. |
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| 37/69/89339 |
Vol 48 - N° 1
P. 71-74 - luglio 1998 Ritorno al numeroBenvenuto su EM|consulte, il riferimento dei professionisti della salute.
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