197 A 13-Month Retrospective Audit of Laparoscopic Cholecystectomy Across a Multi-Site NHS Trust

Abstract Aim To evaluate practice and outcomes of laparoscopic cholecystectomy across a large NHS Trust, assessing indications, imaging pathways, surgical approach, and complications. Method A retrospective audit was conducted on all patients listed for cholecystectomy between January 2024 and January 2025 across three sites. Data included demographics, imaging, surgical modality, complications, and 90-day readmission. Results 675 patients underwent cholecystectomy (73% female, mean age 53.6 years). The most common indication was symptomatic biliary colic (46%), followed by gallstone cholecystitis (28%) and gallstone pancreatitis (14%). Most cases were elective (79%), with CholeQuIC (13%) and emergency (8%) pathways. Laparoscopic surgery was performed in 89.5%, with robotic and subtotal approaches in 3.0% and 4.1%, respectively. Pre-operative ultrasound was performed in 93%, and 36% underwent MRCP. Of those, 31% proceeded to ERCP for stone retrieval. A drain was inserted intra-operatively in 14% of cases. The overall complication rate was 2.2%, including retained stones (1.3%), wound infections (1.3%), and bile leaks (0.9%), with no significant variation based on pre-operative imaging modality. Complication rates were higher in emergency presentations (5.6%) compared to elective cases (2.0%). Readmission rate was 3.9%. Elective cases achieved an 87% day-case rate, exceeding NICE targets. Conclusions Laparoscopic cholecystectomy is delivered safely and consistently across the Trust with excellent outcomes. However, MRCP was used in over one-third of cases, often without influencing complication rates, and may contribute to delays and additional costs. A more selective, evidence-based imaging strategy incorporating intraoperative ultrasound may reduce unnecessary MRCP use, streamline patient care pathways, and improve cost-effectiveness while maintaining clinical safety and outcomes.