WE2.5 Laparoscopic Common Bile Duct Exploration using disposable Bronchoscope and Cystoscope: Case Series in a District General Hospital

Abstract

Abstract Aims Case Series performing Laparoscopic Common Bile Duct Exploration (LCBDE) using single use bronchoscope and cystoscope in a district general hospital. Aim is to explore the safety and efficacy of using single use instruments. Methods Retrospective study of all LCBDE from a single consultant using single use scopes from May 2019 to January 2022. Data collected from Electronic Care Record, notes and theatre management system. Both choledochotomy and transcystic approaches were used. Operations were recorded and outcomes of patients explored. Results Fifteen laparoscopic CBD explorations were carried out during the identified period. Indications included young patients (<50yr) 33.3%, Failed ERCP 13.3%, Referral by gastroenterologist 13.3% and other reasons 40%. The mean age (+/- SD) was 58 (+/-17) and 80% of patients were female. 66.6% of cases were emergencies, 40% had intraoperative cholangiograms, 100% underwent primary closure. The average length of stay (±SD) after the operation was 10 (±8). One patient developed a haemoserous collection that required a laparoscopic washout, one developed post-operative atrial fibrillation and one patient was readmitted with post-operative infection. There were no intraoperative complications or equipment failures. Conclusions The use of disposable bronchoscope and cystoscopes are safe and effective way of performing LCBDE. This approach is also cost effective compared to the more expensive reusable choledocoscope particularly when considering delays due to sterilisation as well as issues with availability in departments. Providing this service in district general hospitals will assist in extensive waiting lists and potentially avoid morbidity associated with ever lengthening waiting lists and reduce pressure on tertiary centres.