O-BN03 Laparoscopic Common Bile Duct Exploration – Delivered within UK NHS Healthcare Framework Free

Cholelithiasis is a common problem in the UK affecting approximately 15% of the population. The incidence of synchronous choledocholithiasis is approximately 10-18%. The approach to bile duct stones is variable. Single stage bile duct exploration and cholecystectomy (LC) vs two stage ERCP followed by LC has been shown to be equally safe and as effective with reduced length of stay and number of procedures. We describe the results of a single, high volume centre performing laparoscopic common bile duct exploration (LCBDE) as an alternative to ERCP.

All patients undergoing LCBDE at our institution from November 2013 – July 2021 were included in the study. Data were collected from a prospectively maintained institutional database and data points corroborated by electronic patient data on hospital systems.

304 patients underwent LCBDE. Median age was 68 (range 21-94). Most cases were performed as urgent/emergency (n = 204, 67% vs n = 100, 33% elective). Bile duct stones were diagnosed pre-operatively in 32.8% cases (n = 100). Intra-operative diagnosis was made using laparoscopic ultrasound (n = 221, 73%), cholangiogram (n = 44, 15%) or combination of both (n = 31, 10%). Laparoscopic completion rate was 92%. Successful stone clearance rate was 98%. 56% were via choledochotomy and 44% trans-cystic. Incidence of bile leak was 4.9% (n = 15). Median length of stay was 2 days post-operatively (range 0–62). The rate of all complications was 13.2%. The rate of mortality was 0.66%.

This is the largest single case series of LCBDE published. This study has demonstrated that a safe and effective LCBDE service can be delivered within the NHS, with outcome data comparable to defined performance standards. With the evolution of specialist training, intra-operative imaging +/- LCBDE is likely to be the preferred modality of treatment.