HPB SO35 - Outcomes of Transcystic Laparoscopic Common Bile Duct Exploration at the time of Laparoscopic Cholecystectomy in patients with small common bile duct diameter

Abstract Background Laparoscopic Cholecystectomy with Laparoscopic Common Bile Duct Exploration (LC+LCBDE) is a single stage therapeutic option for management of choledocholithiasis. There have been limited publications regarding the feasibility of transcystic LCBDE in patients with small (≤8mm) common bile ducts (CBD). This study seeks to examine the outcomes for patients with small ducts who underwent LC+LCBDE via a transcystic approach (LCBDE-t) in a district general hospital over a thirty-month period. Method Prospectively collected data regarding all patients who underwent LC+LCBDE-t over a period from January 2022 to June 2024 was retrospectively reviewed. Data including indication for surgery, CBD diameter, length of stay, complication rate, and readmission rate were determined from Electronic Care Records. Data were analysed using Microsoft Excel. Results 76 patients were identified. CBD diameter (almost all as measured at pre-operative Magnetic Resonance Cholangiopancreatography [MRCP]) ranged from 3.5mm to 8mm (average 6.32). One patient required conversion to open surgery due to difficulties with the LC element of the operation. Median postoperative length of stay was 1 day (range 0-32 days) and readmission rate was 5.33%. Five patients experienced a complication beyond Clavien-Dindo Grade II, with the most serious two being a bile leak and a postoperative bleed, both of which required further surgery. One patient required subsequent Endoscopic Retrograde Cholangiopancreatography (ERCP) for retained CBD stones. Conclusion LCBDE is a safe and effective management option for patients in the setting of choledocholithiasis with small CBD diameter. Small CBD should not necessarily be a deterrent to consideration of transcystic LCBDE as a therapeutic option in appropriately selected patients.