Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
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References
Karsten TM, Davids PH, van Gulik TM, Bosma A, Tytgat GN, Klopper PJ, van der Hyde MN (1994) Effects of biliary endoprostheses on the extrahepatic bile ducts in relation to subsequent operation of the biliary tract. J Am Coll Surg 178(4):343–352
Karsten TM, Coene PP, van Gulik TM, Bosma A, van Marle J, James J, Lygidakis NJ, Klopper PJ, van der Heyde MN (1992) Morphologic changes of extrahepatic bile ducts during obstruction and subsequent decompression by endoprosthesis. Surgery 111(5):562–568
Williams EJ, Green J, Beckingham I, Parks R, Martin D, Lombard M (2008) Guidelines on the management of common bile duct stones (CBDS). Gut 57(7):1004–1021
Chopra KB, Peters RA, O’Toole PA, Williams SG, Gimson AE, Lombard MG, Westaby D (1996) Randomised study of endoscopic biliary endoprosthesis versus duct clearance for bile duct stones in high-risk patients. Lancet 348:791–793
Livingston EH, Rege RV (2004) A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 188:205–211
Tang B, Cuschieri A (2006) Conversions during laparoscopic cholecystectomy: risk factors and effects on patient outcome. J Gastrointest Surg 10:1081–1091
Visser BC, Parks RW, Garden OJ (2008) Open cholecystectomy in the laparoendoscopic era. Am J Surg 195(1):108–114
Spanos CP, Syrakos T (2006) Bile leaks from the duct of Luschka (subvesical duct): a review. Langenbecks Arch Surg 391(5):441–447
Agarwal N, Sharma BC, Garg S, Kumar R, Sarin SK (2006) Endoscopic management of postoperative bile leaks. Hepatobiliary Pancreat Dis Int 5(2):273–277
Cuschieri A (2000) Ductal stones: pathology, clinical manifestations, laparoscopic extraction techniques, and complications. Semin Laparosc Surg 7(4):246–261
Huibregtse K, Tytgat GN (1982) Palliative treatment of obstructive jaundice by transpapillary introduction of large bore bile duct endoprosthesis. Gut 23:371–375
Donelli G, Guaglianone E, Di Rosa R, Fiocca F, Basoli A (2007) Plastic biliary stent occlusion: factors involved and possible preventive approaches. Clin Med Res 5(1):53–60
Massoumi H, Kiyici N, Hertan H (2007) Bile leak after laparoscopic cholecystectomy. J Clin Gastroenterol 41(3):301–305
Zyromski NJ, Lillemoe KD (2006) Current management of biliary leaks. Adv Surg 40:21–46
Dundee PE, Franzi SJ, Thomas PR (2007) Unique complication of a biliary stent: erosion through the common hepatic duct wall. ANZ J Surg 77(3):194
Vinod J, Palance A, Haber G (2008) An unusual complication of a gastrocystic stent in the management of pancreatic pseudocyst. Gastrointest Endosc 67(7):1199–1201
De Palma GD, Cantanzano C (1999) Stenting or surgery for treatment of irretrievable common bile duct calculi in elderly patients? Am J Surg 178:390–393
Diller R, Senninger N, Kautz G, Tübergen D (2003) Stent migration necessitating surgical intervention. Surg Endosc 17(11):1803–1807
Davids PH, Groen AK, Rauws EA, Tytgat GN, Huibregtse K (1992) Randomised trial of self expanding metal stents versus polyethylene stents for malignant biliary obstruction. Lancet 340:1488–1492
Johanson JF, Schmalz MJ, Geenen JE (1992) Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 38:341–346
Levey JM (2002) Intestinal perforation in a parastomal hernia by a migrated plastic biliary stent. Surg Endosc 16:1636–1637
Størkson RH, Edwin B, Reiertsen O, Faerden AE, Sortland O, Rosseland AR (2000) Gut perforation caused by biliary endoprosthesis. Endoscopy 32(1):87–89
Ikeda T, Nagata S, Ohgaki K (2004) Intestinal obstruction because of a migrated metallic biliary stent. Gastrointest Endosc 60(6):988–989
Mistry BM, Memon MA, Silverman R, Burton FR, Vanna CR, Solomon H, Garvin PJ (2001) Small bowel perforation from a migrated biliary stent. Surg Endosc 15:1043
Fiori E, Mazzoni G, Galati G, Lutzu SE, De Cesare A, Bononi M, Bolognese A, Tocchi A (2002) Unusual breakage of a plastic biliary endoprosthesis causing an enterocutaneous fistula. Surg Endosc 16:870
Pathak AK, de Souza LJ (2001) Duodenocolic fistula: an unusual sequela of stent migration. Endoscopy 33:731
Bergqvist D, Pärsson H, Sherif A (2001) Arterio-ureteral fistula—a systematic review. Eur J Vasc Endovasc Surg 22(3):191–196
Silecchia G, Restuccia A, Elmore U, Polito D, Perrotta N, Genco A, Bacci V, Basso N (2001) Laparoscopic adjustable silicone gastric banding: prospective evaluation of intragastric migration of the Lap-Band. Surg Laparosc Endosc Percutan Tech 11(4):229–234
Holeczy P, Novak P, Kralova A (2001) 30% complications with adjustable gastric banding: what did we do wrong? Obes Surg 11:748–751
Kellum JK (2003) Gastric banding. Ann Surg 237(1):17–18
Acknowledgment
The authors express their sincere gratitude to Mr. L. Meleagros, Consultant in Colorectal Surgery; Mr. R. Navaratnam, Consultant in Colorectal Surgery; Mr. D. L. Stoker Consultant in Upper GI Surgery; Miss F. Myint, Consultant in General and Vascular Surgery; Mr. A. Jadeja Associate Specialist in Surgery; and Mrs. C. H. Stabler, Senior Sister, Ian Wolf Endoscopy Unit, all at the North Middlesex University Hospital, London, UK; and Dr. S. Panesar for the help and support in conducting this study.
Disclosures
M. S. Nair, M. M. Uzzaman, O. Fafemi, and A. Atthow have no conflicts of interest or financial ties to disclose.
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Nair, M.S., Uzzaman, M.M., Fafemi, O. et al. Elective laparoscopic cholecystectomy in the presence of common bile duct stent. Surg Endosc 25, 429–436 (2011). https://doi.org/10.1007/s00464-010-1185-9
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DOI: https://doi.org/10.1007/s00464-010-1185-9