Transcystic stenting with postoperative ERCP - a safe alternative to intraoperative rendezvous ERCP for the treatment of common bile duct stones

Abstract Introduction Common bile duct stones (CBDS) diagnosed by cholangiography during laparoscopic cholecystectomy, are preferably treated by intraoperative endoscopic retrograde cholangiopancreatography with rendezvous technique (RV-ERCP). An alternative treatment is laparoscopic, transcystic placement of an endobiliary stent and postoperative ERCP (TCStent-ERCP). The aim of this study was to compare these two treatment strategies regarding complication rates. Method This retrospective study was based on data from GallRiks, the Swedish Registry for Gallstone surgery and ERCP. We extracted data on cholecystectomies performed at three hospitals 2010-2023, with intraoperatively detected CBDS, and ERCP in the same session or later. Procedures involving TCStent-ERCP or RV-ERCP were identified. Complications within 30 days, related to the cholecystectomy as well as to the ERCP were compared between the two groups. Result In total, 929 patients were included. The overall complication rates were 21/183 (11%) in the TCStent-ERCP group and 140/746 (19%) in the RV-ERCP group. Adjusted multivariable analysis demonstrated fewer overall complications with the TCStent-ERCP strategy compared to RV-ERCP (OR 0.60, 95%CI 0.35-0.97), but no statistically significant difference was observed between the groups for surgical complications or post procedural pancreatitis. Discussion Transcystic stenting with postoperative ERCP appears to be a safe alternative to intraoperative rendezvous ERCP for the management of CBDS encountered during cholecystectomy. This might be beneficial, particularly in surgical units without the resources to perform unplanned ERCP.