EP.FRI.530 ‘Emergency’ Laparoscopic Common Bile Duct (CBD) Exploration: Is this the right time to change?

Abstract

Abstract Aims Common Bile Duct (CBD) stones are becoming more common on surgical emergency take and accounts for up to 20 % of patients presenting with acute biliary pathologies. The hospital stay is prolonged whilst waiting for Endoscopic Retrograde Cholangio Pancreatography (ERCP). We aim to evaluate the feasibility, safety and cost-effectiveness of emergency laparoscopic CBD exploration (LCBDE) in these patients. Methods A cohort of patients with CBD stones underwent emergency LCBDE between January 2016 and December 2020 at a regional hospital in the United Kingdom was retrospectively reviewed. Results In total, 11 LCBDE were performed on emergency list. All patients were admitted with acute symptoms of either obstructive jaundice cholangitis or pancreatitis. All procedures were performed with choledochotomy. The mean patient age was 58 years and male-to-female ratio was 2:9. 3 patients (27%) had T- tube otherwise all ducts were primarily closed. Average hospital stay was 8.5 days. 1 patient returned to theatre for retained stone of 11mm. There was no 30 days mortality. There were no readmissions. Initial analysis with small number of patients showed, performing these procedures on emergency basis not only improved patient’s overall experience but also benefitted NHS Trust by approximately £18,500 as per the National Tariff System 2020/21. Conclusions Emergency LCBDE is safe, feasible and cost effective. We can safely aim to increase the proportion of LCBDE performed as an emergency case, where clinically appropriate, to reduce the financial burden and improve patient’s outcome with overwhelming NHS Trust funds.