302 Establishment and Impact of an Emergency Biliary Service at a University Hospital

Abstract Aim An emergency biliary service was established in December 2021 at our university hospital, based on index-admission cholecystectomy, and single-stage surgical management of CBD stones. The aim was to streamline care pathways, reduce delays, and minimize reliance on multi-stage endoscopic procedures. Method This was a retrospective analysis of a prospectively maintained database of all patients referred to the emergency biliary service and operated on by a single surgeon between December 2021 and December 2024. Data collected included clinical indication, procedure type and referral-to-surgery interval. ERCP volumes and age trends from 2015–2022 were reviewed from a previous study for comparison. Results Between December 2021 and December 2024, 941 biliary referrals resulted in 581 laparoscopic cholecystectomies, 96.5% with Intraoperative Cholangiography, and 48% CBD explorations, 96.5% via transcystic route. Of these, 476 patients (81.9%) underwent surgery during index admission (≤14) days, with an average wait of 2.6 days from the time of referral. Theatre utilisation included 253 cases (43.5%) on emergency lists, 313 (53.8%) on elective lists, and 10 (1.7%) on extra lists. In 2022, ERCP volumes fell to 450, representing a 24.6% reduction compared to the previous 5-year average of 597 procedures per year. ERCPs for stone disease dropped from 80% to 71% (p < 0.001), with use in patients under 30 years falling from 4% to 1% (p = 0.042). Conclusions The emergency biliary service enabled timely, single-stage management of biliary pathology, optimising theatre use and reducing ERCP need in a tertiary care.