ThP6.2 - Benign and malignant biliary strictures encountered during single session laparoscopic cholecystectomy and bile duct exploration. Rationalising preoperative imaging and relying on routine cholangiography can optimise outcomes

Abstract Aim To review causes, diagnostic features and operative strategies of biliary strictures discovered on routine cholangiography (IOC) during single session treatment of bile duct stones. Methods A prospective database of cholecystectomies and bile duct explorations spanning 30 years was analysed. Cross sectional imaging and ERCP play a limited role in patients with confirmed gall stones except in suspected malignancies. Results 53/6140 patients (0.86%) had strictures on IOC.Malignant Strictures 27 (%)Benign strictures 26 (%)Females18 (66.6)12 (46)Age Median7262Emergency admission24 (88.8)15 (57.7)Presentation: Jaundice22 (81.5)15 (57.7)USS: GB Thick or contracted6 (22.2)4 (15.4)Bile duct dilatation16 (59.2)14 (53.8)Suspected CBD stones23 (85.2)24 (92.3)Preoperative imaging: MRCP1 (3.7)6 (23)CT6 (22.2)4 (15.4)ERCP1 (3.7)5 (19.2)Gall bladder conditionMucocele10 (37)3 (11.5)Acute/Empyema6 (22.2)4 (15.4)Contracted5 (18.5)9 (34.6)Cholangiography abnormality:Strictures + dilated ducts12 (44.4)22 (84.6)Dilated ducts/stones/no flow15 (55.5)4 (15.4)Bile Duct Exploration:Choledochotomy17 (63)10 (38.4)Transcystic5 (18.5)11 (42.3)NONE5 (18.5)5 (19.2)Choledochoscopy21 (77.7)20 (76.9)Biliary drains13 (48)18 (69)Stents9 (33.3)3 (11.5)Operative time (median)135 min135Open conversion1 Bilioenteric anastomosis0Morbidity4 (14.8)7 (26.9)Hospital stay median1413Postoperative ERCP11 (40.7)11 (42.3)Postoperative surgery322 year survival122 Conclusions Careful clinical assessment and exclusion of risk of malignancy optimises preoperative imaging and maximise benefits of single session management of suspected CBD stones.