We usually implant stents in case of stenosis or major leak after surgery. So far i  don't think there's any scientific evidence of preventive stenting even because could increase the incidence of cholangitis if placed transpapillary

Dear Pierleone, do you think it's time for a trial which investigate primary duct closure vs biliary stent insertion after choledochotomy performed in emergency settings? I mean, cholangitis and so on...

Thank you very much

I would recommend following the same indications we use with ERCP-based CBD interventions.  This would generally include strictures, retained stones, cholangitis, casts, retained blood clot, leaks or perforations, and/or significant edema at the sphincter after sphincterotomy/balloon dilation. Some of this would depend on the location of the lesion or problem of course, and might require collaboration with an ERCP provider or PTC provider. 

There is no well-documented indication for 'preventive' stenting in ERC. T-tube placement after LCBDE in the absence of these problems would likely only increase post-op complication risks.  We found this to be the case over a long history of routinely using t-tubes in duct-to-duct anastamosis in OLT.

However, there is opinion that bleeding risk, from GDA injury (via CBD manipulations and pseudoaneurysm) or portal hypertension - associated intraductal varices, can be reduced by fully covered metal stent or a 'tight-fitting' plastic stent. 

best regards