Index admission vs elective laparoscopic common bileductexploration: adistrictgeneralhospitalexperience over 6years.

Abstract

Laparoscopic common bile duct exploration (LCBDE) is relatively a new approach for clearing choledocholithiasis. The aim of this study is to assess the safety ofthisapproachtoclearing common bile duct (CBD) stones on an index admission including emergency setting. Retrospective data collectionand analysiswerecarried out for 207 consecutive cases of LCBDE performed in Royal Cornwall Hospital over 6years (2015-2020).Patientswere dividedinto two groups (Index admission vs elective) then both groups compared. A total of 207 cases of LCBDEwereperformed in our unitduring the time period.One hundred twenty-two operations were performed on the index admission and 85 on a subsequent elective list. Mean operative time was 146 ± 64minin the index admission group and 145 ± 65minin the elective group(p = 0.913). Length of stay post-operatively was 3.3 ± 6.3daysin the index admission cases and 3.5 ± 4.6daysafter elective cases. Successful clearance was achieved at the end of the operation in 116 patients in the index admission group, clearance failed in one case and negative exploration in 5 patients. In the elective group 83 patients had a successful clearance at the end of the operation, and 2 patients has had a negative exploration. Twelve patients(index admission group) and 8 patients of the elective cases required post-operative Endoscopic Retrograde Cholangiopancreatography (ERCP) to manage retained stones, recurrent stones and bile leak(p = 0.921). Three patients required re-operation for post-operative complications in each group. Common bile duct exploration in index admissionis safe with high success rateif performed by well-trained surgeons with advanced laparoscopic skills.