66 Common Bile Duct Exploration in the District General Hospital: Safe, Feasible, and Effective

Abstract Aim Laparoscopic common bile duct exploration (LCBDE) offers a single-stage alternative to ERCP for choledocholithiasis. This study assesses the safety and effectiveness of introducing LCBDE in a district general hospital setting. Method This single-centre prospective case series included all consecutive patients undergoing LCBDE between August 2022 and June 2025, following the establishment of a dedicated biliary service led by two surgeons. Outcomes were benchmarked against BBUGSS Key Performance Indicators. Results A total of 92 patients underwent LCBDE; median age was 52 years (IQR 36–64), and 63 (68.5%) were female. Emergency surgery was performed in 50 cases (54.3%). 72 (78.35) were referred from other teams. Median BMI was 30 (IQR 27–35). LCBDE was transcystic in 83 patients (90.2%) and via choledochotomy in 8 (8.7%); one case (1.1%) converted from transcystic to choledochotomy. Among transcystic cases, 75 (90.4%) used the choledochoscope and 8 (9.6%) employed the basket-in-catheter technique. Median postoperative stay was 1 day (IQR 0-2).Key Performance IndicatorBBUGSS StandardOur outcomeConversion rates<10%0%Bile duct clearance rates>85%94.6%Bile Leak Rates<5%1.1%Returns to theatre<5%0%Readmission rates (within 30 days)<15%7.6%Overall Morbidity<15%5.4%Overall Mortality<1%0% Conclusions Our early experience demonstrates that LCBDE is a safe and effective option in both elective and emergency settings, even during the infancy of a biliary service, while avoiding the risks of a two-stage ERCP approach.