Laparoscopic CBD exploration and the long-term effect of ante-grade biliary stents

Abstract

Aims: Laparoscopic common bile duct (CBD) exploration is now a standard treatment for CBD stones, however debate still remains as to whether the CBD should be closed primarily or an ante-grade biliary stent placed. A recent Cochrane review suggested further information was required regarding long-term effects of both options. This study aims to review the long-term effects of laparoscopic CBD exploration with ante-grade biliary stents. Methods: A retrospective review of all patients who underwent laparoscopic CBD exploration with biliary stent, from 2008 to 2014, by a single surgeon, was performed. The procedure was standardized and biliary stents were removed by OGD at 6 weeks post procedure. Patient demographics, co-morbidities, operative and post-operative details, along with follow-up data were collected from 2008 to date. Follow-up data included liver function tests, further imaging and procedures required. Results: 142 patients were included with a 19% (n = 27) rate of conversion. The mean age was 55.7 years, with 52 male patients. Post-operative complication rate is 9.1%, including minor bile leak (managed conservatively) 4.9%, bleeding 1.4%, fistula 0.7%, blocked stent 0.7% and wound infection 0.7%. There is a zero mortality rate. Long-term follow-up in the laparoscopic group found deranged LFTs in 10% of the group (mainly isolated GGT). 30 patients had an USS following their initial surgery, of which 80% were reported as normal. 15 patients had an MRCP - 3 had a possible stricture, none of which were confirmed at ERCP; and 6 had choledocholithiasis requiring ERCP (n = 4) or hepaticojejunostomy (n = 2). Conclusions: This study demonstrates laparoscopic CBD exploration with ante-grade biliary stent is a safe procedure with no major post-operative complications. The long-term follow-up has demonstrated no major complications associated with the use of a biliary stent, however further randomized controlled trials are required to validate this further.