Rate of Choledocholithiasis on Routine Intra-operative Cholangiogram and their Management in a Regional Australian Hospital

Abstract

Methods: A retrospective audit of all elective and emergency cholecystectomies and their IOCs from January 2019 to December 2019 was done. The method of management and their outcomes were evaluated. Results: 113 emergency cholecystectomies were performed with a 93% (105/113) rate of intra-operative cholangiograms. Of these 19% (20/105) found filling defects on IOC. 14 underwent laparoscopic exploration with a choledochoscope of which 10 were successful. 6 were managed with a referral to a tertiary centre for an ERCP. The remaining 4 were either successfully flushed, milked out or left to pass spontaneously. For emergency cholecystectomies, laparoscopic CBD explorations added 48 minutes to operation time (185 vs 137 minutes). Hospital stay for laparoscopic CBD exploration was an average of 4.4 days while patient managed with an inter-hospital transfer and ERCP had a total average hospital stay of 8.0 days. For elective cholecystectomies, 90% (65/70) had an IOC of which 3 found choledocholithiasis. All 3 were successfully managed with a choledochoscope. Conclusion: In a regional Australian hospital with no in-house ERCP facilities, laparoscopic treatment of choledocholithiasis is safe, efficient and reduces the duration of hospital stay and the cost of an inter-hospital transfer.