Biliary cutaneous stent insertion via T-tube tract by choledochoscopy

Background: Postoperative biliary ductal dilation and stent insertion are mandatory for managing complicated residual hepatolithiasis with intrahepatic strictures. Usually this procedure is performed under fluoroscopic guidance. Choledochoscopic examination is a routine procedure for residual hepatolithiasis. This is the first report of choledochoscopic biliary cutaneous stent insertion. Methods: Fifty-three patients underwent biliary cutaneous stent insertion under postoperative choledochoscopic guidance. Of the 53 patients, 35 had strictured intrahepatic ducts, 6 a stenotic hilum, 9 a tortuous fistula tract and 3 a choledochoduodenocutaneous fistula. Results: A total of 120 procedures have been performed in the 53 patients. Two thirds necessitated a repeated procedure. No major complication was found except 2 patients experienced mild abdominal pain after the procedure. Neither fluoroscopy nor contrast medium was used. Conclusions: Choledochoscopic guidance is effective for postoperative biliary cutaneous stent insertion. It has the advantage of being technically easy and is relatively safe.