34 Laparoscopic Cholecystectomy and CBD Exploration: A Dedicated Pathway Implementation and Outcomes in a DGH Hospital

Abstract Aim Laparoscopic common bile duct exploration (LCBDE) during cholecystectomy offers a single-stage minimally invasive alternative to the traditional two-stage treatment involving laparoscopic cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP). This audit evaluates the outcomes of LCBDE cases performed between 2021 and 2025, benchmarked against the British Upper Gastrointestinal Society Standards (BBUGSS) Key Performance Indicators (KPIs). Method A retrospective review was conducted on 63 patients undergoing dual-operator LCBDE procedures. Inclusion criteria mandated a bile duct diameter ≥10 mm for choledochotomy or ≥8 mm for trans-cystic exploration performed by experienced surgeons. Primary endpoints assessed were conversion to open surgery, duct clearance rates, bile leak incidence, return to theatre, readmission within 30 days, overall morbidity, and mortality rates. Results Out of 63 cases, conversion to open surgery occurred in 3.1%, well below the 10% KPI threshold. The duct clearance rate was 98.2%, with only one patient requiring postoperative ERCP for residual stones. Bile leak incidence was 1.5%, with a single patient necessitating stenting. Return to theatre rate was 3.1%, readmission rate within 30 days was 1.5%, and overall morbidity was 4.7%. There were no mortalities. Trans-cystic exploration was successfully performed in 8 cases, with half discharged on the same day. Conclusions LCBDE is a safe and effective single-stage treatment for choledocholithiasis when performed by experienced surgeons in appropriately selected patients. The outcomes in this audit meet or exceed BBUGSS KPIs, supporting the wider adoption of LCBDE as an alternative to the two-stage approach. Patients should be counselled about this option when a dedicated LCBDE service is available.