SP8.1.1 Emergency Vs Elective Common Bile Duct Exploration, A District General Hospital Experience over 6 years

Abstract

Abstract Introduction Laparoscopic Common bile duct exploration (LCBDE) is a relatively new approach for clearing choledocholithiasis. The aim of this study is to assess the feasibility of this approach to clearing CBD stones in an emergency setting. Methods Retrospective data collection and analysis was carried out for 207 consecutive cases of LCBDE performed over 6 years (2015–2020). The patients were divided into two groups according to the operation performed as an emergency or elective. We compared demographics, perioperative data, post-operative complications, and outcomes. Results 207 cases of LCBDE were performed during the time period. 122 performed as an emergency, and 85 on an elective list. Of the emergency cases, 37 performed because of cholangitis either mild or moderate in severity according to Tokyo grading system. Ninety-six percent of the emergency cases and 94.1% of the elective cases were completed laparoscopically. Length of stay post-operatively was 3.3 +6.3 days in the emergency and 3.5 +4.6 days after elective. Successful clearance achieved at the end of the operation in 99% of the patients in the emergency group, clearance failed in one case. In the elective group 100% of the patients has a successful clearance at the end of the operation. Twelve patients (emergency) and 8 patients of the elective cases required post-operative ERCP to manage retained stones, recurrent stones or bile leak (p=0.921). Three patient required re-operation for post operative complications in each group. Conclusion Common bile duct exploration in emergency settings is feasible, with high success rate if performed by surgeons with advanced laparoscopic biliary skills.