EGS P32V Laparoscopic transcystic Antegrade Biliary Stenting

Abstract Background Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis including pancreatitis. Symptomatic gall stones patients have up to 20% risk of having common bile duct (CBD) too. Although, guidelines been laid down management suspected CBD stones, in practice there a lot variability and lack standardisation. The waiting list Magnetic resonance cholangiopancreatography (MRCP) long, resulting delayed increased length hospital stay. Similarly, pre-operative endoscopic retrograde (ERCP) can also increase stay due long lists, limited availability overall complications as high 30%. Hence, role on-table cholangiogram (OTC) while performing laparoscopic has explored. state that OTC should be performed fit surgery patients, without investigations diagnosing stones. We practising early with (during index admission), selective insertion antegrade biliary stent choledocholithiasis. facilitate ERCP removal clearance after 4 weeks post-operatively. aim present our technique insertion. Methods follow four-port cholecystectomy. Following dissection Calot's triangle visualisation ‘critical view safety’, an using technique. If are visualised, transcystic stenting done by Seldinger (without clearing stones). catheter removed flex-tip ureteric inserted transcystically. Through guidewire into till its tip visualised duodenum, under C-arm guidance. ureteral then withdrawn carefully placed satisfactorily. A double pig tail end rail-roaded over guidewire, pushing fashioned appropriately. As soon beyond ampulla (in X-ray), withdrawn. curling both ends confirmed through Thereafter procedure cholecystectomy, standard, completed. Results results this were analysed from 2014 2017, subsequently published 2018. Conclusions This does not involve skills required exploration. general surgeons expertise minimal access surgeries, it steep learning curve. safe, reliable cost-effective. It decreases delays decompression, in-hospital ensures timely treatment.