Implementation of a simplified self-releasing biliary stent in choledocholithiasis: Experience in 150 cases

Abstract

Introduction: Our aim was to introduce a simple way of making a self-releasing biliary stent for laparoscopic common biliary duct exploration.

Methods: To make a self-releasing biliary stent, an absorbable thread was sutured to a J-shape polyurethane biliary stent. After the evacuation of the calculi, a guide wire was placed into the duodenum antegradely, facilitating the insertion of the biliary stent. The pigtail of the stent was left in the duodenum. The choledochotomy was then sutured, with the absorbable thread left outside the bile duct.

Results: This study consisted of 150 patients with choledocholithiasis. The mean operating time was 126 ± 36 minutes. The postoperative hospital stay was 6.5 ± 3.6 days. In 149 cases, the biliary stents were released and discharged out of the body with feces. The inside body time of the rapid-releasing stent was 13.6 ± 2.6 days, and it was 28.0 ± 4.6 days for the slow-releasing stent. One stent was removed by endoscopy. Transient hyperamylasemia occurred in 32 patients (21.3%) without clinical onset of pancreatitis. Bile leakage occurred in three patients (2.0%), all of whom recovered after treatment. Residual lithiasis was found in one patient (0.7%) and was retracted by endoscopy 30 days after the first procedure. No infection or dislocation of the stent was found.

Conclusion: For laparoscopic common biliary duct exploration for choledocholithiasis, this method provides an alternative way to make a simple and safe self-releasing stent. It enables the endoscopic retraction of biliary stents to be avoided.

Keywords: ERCP; biliary stent; choledocholithiasis.