A Snapshot of the Practice of Laparoscopic Common Bile Duct Exploration in the United Kingdom - (CholeS Data Set)

Abstract

Introduction: The aim was to describe the utilisation/practice of laparoscopic bile duct exploration(LCBDE) option for the management of common bile duct stones across the UK. The data were obtained from a population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases (CholeS study). Methods: We used the CholeS Study DataSet to analyse the use of LCBDE in the UK. Descriptive analysis and graphs were used to illustrate the current practice of LCBDE in the UK. Results: Seventy-seven (46%) out of 167 Hospitals that took part in the CholeS study performed LCBDE. Their LCBDE workload was 5.4% out of the total Laparoscopic Cholecystectomies(LC) performed. Almost 90% of LCBDE was performed by hospitals who performed less than five LCBDE in two months. Only 5.2% of hospitals performed more than 10 LCBDEs; this accounts for 19.8% of their LC workload compared to between 2 and 8% for the rest. Out of 8820 LC, a total of 256(2.9%) and 932(10.6%) patients underwent LCBDE and pre-operative endoscopic retrograde cholangio-pancreatography and sphincterotomy(ERCP+ES) respectively for CBDS. Eighty-four per cent of LCBDEs were performed by Upper gastrointestinal surgeons and 16% by other specialities including 10% colorectal surgeons. Interestingly, only just under 5% of the LCBDEs were performed by trainees. Conclusions: In the UK, a significant proportion of patients with CBDS are still treated in two stages: a pre-operative ERCP followed by LC. LCBDE remains an underutilised resource in the UK. Further studies are required to examine the possible reasons for the low utilisation of LCBDE.