title: Laparoscopic management of common bile duct stones: transpapillary stenting or external biliary drainage?
abstract: BACKGROUND
  To date, the management of common bile duct stones (CBDs) is still controversial. If laparoscopic exploration is performed and biliary decompression is needed after stone removal, the placement of a laparoscopic transpapillary stent shows promising results in avoiding T-tube-related complications.
  
  
  METHODS
  Between January 2007 and May 2012, a series of 48 patients who underwent biliary decompression after laparoscopic common bile duct exploration (LCBDE) to treat choledocholithiasis was retrospectively analyzed. The results in patients with transpapillary stent placement (TS=35) were compared with those who had an external biliary drainage (EBD=13).
  
  
  RESULTS
  LCBDE and TS placement was achieved either by a choledochotomy or through the cystic duct. There was no mortality in our series. Patients with an external biliary drainage (EBD) had more surgery-related complications (P<.0001) and a longer hospital stay (P=.03). Postoperative ERCP to remove the TS was successful in all cases.
  
  
  CONCLUSIONS
  Laparoscopic TS is a safe method in the treatment of selected patients with CBD stones that can be achieved without having to perform a choledochotomy. Because of the lower morbidity and the shorter hospital stay compared with EBD, it should be considered as a first approach whenever biliary decompression is needed after LCBDE.
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Agustin
authors.initials: A
authors.lastname: Dietrich
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Alvarez
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Resio
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Oscar
authors.initials: O
authors.lastname: Mazza
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibañes
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Juan
authors.initials: J
authors.lastname: Pekolj
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Rodrigo Sanchez
authors.initials: RS
authors.lastname: Clariá
authors.affiliation: Department of General Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Martin
authors.initials: M
authors.lastname: de Santibañes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents
keywords: Biliary drainage; Choledocholithiasis; Common bile duct stones; Laparoscopy