Biliary Complications Research Articles

Perioperative Complications After Pediatric Liver Transplantation-A Retrospective Analysis of 421 Cases.

Due to the low incidence of pediatric liver transplantations, short- and long-term data regarding their outcome, details on early postoperative complications and their risk factors are under-represented in the literature. We retrospectively reviewed 1645 LTx performed at Hannover Medical School between January 2005 and December 2021. Of these, 421 transplantations were performed in 405 pediatric recipients. Univariate and multivariate binary logistic regressions were performed to identify independent risk factors for the onset of selected perioperative complications requiring intervention within the first 30 days following transplantation and their influence on graft and patient survival. Pleural effusions represent the most common postoperative complication observed in 49.4% (n = 208) of cases, followed by vascular complications in 22.6% (n = 95) and biliary complications in 20.0% (n = 84) of cases. Donor age (OR: 1.019; p = 0.010) and recipient age between 3 and 12 years (OR: 1.849; p = 0.008) were identified as independent risk factors for the onset of pleural effusions. Retransplantations within the first year after LTx were necessary in 11.4% of all cases (n = 48). Twenty (4.8%) patients died within the first year after LTx. Pleural effusions requiring postoperative intervention were observed in approximately half of the pediatric recipients. Therefore, the preemptive intraoperative placement of a chest drain under sterile conditions and general anesthesia should be considered. Our data further indicate that a two-stage procedure for biliary reconstruction may be the preferred procedure in patients at risk of early bile duct complications and retransplantation within the first year.

Imaging of Ischemic Cholangiopathy Following Donation after Circulatory Death Liver Transplant.

Ischemic cholangiopathy (IC) is the leading cause of inferior long-term outcomes following donation after circulatory death (DCD) liver transplant. Biliary strictures related to IC are nonanastomotic strictures (NASs) by definition and involve the donor hepatic ducts proximal to the anastomosis, compared with postsurgical anastomotic strictures that form due to fibrotic healing. IC-related NASs can be microangiopathic with patent hepatic artery or macroangiopathic with occluded or stenotic hepatic artery. Recently, IC with NASs have been described to have four distinct patterns at imaging: diffuse necrosis, multifocal progressive, confluence dominant, and minor form, which correlate clinically with graft prognosis. Severe IC can lead to ductal wall breakdown with subsequent bile leaks that can cause significant patient morbidity, with imaging playing a vital role in diagnosis and guiding intervention. IC also predisposes the transplanted liver to biliary stasis and subsequent formation of stones, casts, and sludge. Some cases of posttransplant biliary stricturing are not IC but are a sequela of reflux cholangitis seen with choledochojejunal anastomosis. Other biliary findings in the posttransplant liver can be explained by sphincter of Oddi dysfunction that results from denervation. The authors describe and comprehensively categorize the various IC types and their imaging patterns at MRI and MR cholangiopancreatography, review the prognostic significance of these imaging patterns, and discuss imaging features of additional biliary complications associated with IC after DCD liver transplant. ©RSNA, 2024 Supplemental material is available for this article.

Long term (15 year) complications & outcomes after liver transplantation for primary sclerosing cholangitis: Impact of donor and recipient factors.

With longer survival of patients with PSC undergoing liver transplantation (LT), the frequency and risk factors associated with vascular and biliary complications in the allograft and the impact on long-term outcomes are poorly understood. To assess frequency and risk factors for long term outcomes in patients post-LT for PSC. All LT recipients for advanced stage PSC for non-cholangiocarcinoma indication from 1984-2012, with follow-up through March 2022 (>10+year followup) were idenitfied. 1-, 5-, and 10-yr cumulative risks of complications were estimated using the Aalen-Johansen method, where death was considered a competing risk. Two hundred ninety-three patients (mean age, 47.3±12y), formed our study cohort. One hundred and thirty-four patients received LT before 1995 and the 159 were transplanted after 1995. Over a median (interquartile range) follow-up of 15.0 (10.3-22.1) years, LT was complicated by hepatic artery thrombosis (N=30), portal vein stenosis/thrombosis (N=48), biliary leak (N=47), biliary strictures (N=87), rPSC (N=107), and graft failure (N=70). The 1-, 5-, 10-, and 15-year cumulative incidence of rPSC was 1.0%, 8.0%, 23.5%, and 34.3% respectively. Type of donor and older donor age were associated with increased risk of biliary strictures. Donor age >60 years was associated with increased risk of rPSC. Long-term patient and graft-survival have not changed significantly for patients transplanted for PSC. Controlling transplant related factors such as donor age, prompt identification of vascular and biliary complications early and long-term rigorous followup is recommended to continue to improve on these outcomes.

Our experience of laproscopic cholecystectomy with associated complications and their treatment: a study of 200 cases

Background: The aim of this study was to evaluate the intraoperative and postoperative complications of laparoscopic cholecystectomy along with their treatment. Methods: The study was conducted in a tertiary care government teaching hospital in central Gujarat, India. And conventional laparoscopic cholecystectomy was performed after all relevant investigations. Results: In our analysis of 200 cases of planned laparoscopic cholecystectomy, we have found that the median age of patients undergoing operation was 47 years. In our study, 140 (67%) of the patients were female and 60(33%) male cases. It is noted that there were more complications in male patients (OR=2.95, CI 95%, 1.42-4.23, p<0.001). The total number of complications were 60 (30%) out of which 45 (22%) were found to be intraoperative complications and rest were post operative complications. In our study, most common complication encountered was iatrogenic perforation which caused spillage of stones or bile 35 (17.5%) followed by bleeding from gallbladder fossa 12 (6%). CBD injury which is one of the most dreaded complications of laparoscopic cholecystectomy occurred in only 1 patient (0.5%). Among the post operative complications bleeding from abdominal cavity 12 (6%), bilioma 7 (3.5%) and infection of surgical wounds 4 (1.5%) were common. There was a total rate of 5% conversions to open surgery. Conclusions: Adopting laparoscopic cholecystectomy as a new technique for treatment of cholelithiasis, introduced a new spectrum of complications. Major biliary and vascular complications are life threatening, while minor complications cause patient discomfort and prolongation of the hospital stay. It is important recognizing IOC complications during the surgery so they are taken care of in a timely manner during the surgical intervention.

Propensity Score-matched Donor and Recipient Outcomes: Robotic Versus Laparoscopic Donor Right Hepatectomy.

Few studies have examined the long-term outcomes of recipients in minimally invasive donor hepatectomies, particularly comparing robotic and laparoscopic donor procedures. Understanding these outcomes is crucial for optimizing surgical approaches and improving the overall success of living donor liver transplantation. This study aimed to compare the feasibility and safety of robotic donor right hepatectomy (RDRH) and laparoscopic donor right hepatectomy (LDRH) by evaluating total follow-up patient outcomes. This retrospective, single-center study included 117 and 118 donors who underwent RDRH and LDRH between March 2016 and June 2023, respectively. After performing 1:1 propensity score matching, 71 donor-recipient pairs were included in each group. Donor and recipient complications were divided into early (within 90 d) and late (after 90 d) biliary and vascular complications. In the matched cohort, major complication rates of donors were similar in both groups. Bile duct (BD) variation was not significantly different; however, the rates of multiple BD openings (26.8% versus 54.9%; P = 0.001) and major biliary complications in recipients were higher in the LDRH group (22.5% versus 42.3%; P = 0.012). The cumulative biliary complication rate was significantly higher in the LDRH group. Early biliary complications were not significantly different; however, the rate of late biliary complications was higher in the LDRH group (11.3 versus 23.9%; P = 0.047). RDRH demonstrated comparable postoperative complications to LDRH in donors but showed fewer recipient biliary complications. This could be attributed to the precision of robotic dissection and BD division, resulting in fewer multiple BD openings.

Dual hypothermic oxygenated machine perfusion of the liver reduces post transplant biliary complications - a retrospective cohort study.

Corroborating evidence for use of hypothermic oxygenated machine perfusion (HOPE) prior to orthotopic liver transplantation (OLT) suggests a beneficial effect in regards to biliary complications. Here, we aim to evaluate whether perfusion via portal vein alone (sHOPE) or via additional perfusion of the hepatic artery (dHOPE) have diverging impact on outcomes after OLT when compared to use of static cold storage (SCS). Consecutive patients undergoing OLT at Medical University of Vienna (2018 to 2023) were retrospectively analyzed. Donor organs were procured using SCS, or subjected to end-ischemic sHOPE or dHOPE. Severity of biliary complications was classified according to degree of therapeutic intervention (endoscopic retrograde cholangiopancreatography or surgical revision). 247 patients were included (69 SCS, 76 sHOPE, 102 dHOPE). Hospitalization was shorter for patients after HOPE (median in days: SCS=25 vs HOPE=20, P=0.019). Biliary complications were less frequent in patients after HOPE (SCS=37.7% vs HOPE=22.5%, P=0.015). A significantly lower incidence of surgical revisions for biliary complications was observed in the HOPE cohort (24.6% vs 11.8%, P=0.012). When evaluating outcome according to HOPE-modality, a significant reduction in biliary complications (P=0.006) and surgical revisions (P=0.002) was only observed in dHOPE patients in comparison to SCS. Further, only dHOPE was significantly associated with reduced need for surgical revision for biliary complications upon uni- and multivariable logistic regression (odds ratio=0.336, P=0.011). HOPE leads to a reduction of biliary complications and associated surgical revisions. This effect seems to be primarily associated with use of dHOPE, while both methods appear as feasible options for preconditioning of donor grafts prior to OLT.

Safety and feasibility of pure laparoscopic living donor right hepatectomy.

Pure laparoscopic living-donor right hepatectomy (PLDRH) has emerged as a significant advancement in liver transplantation, offering reduced donor morbidity and improved recovery times. However, PLDRH is still performed in only a limited number of centers. This retrospective study reports on the outcomes of 215 living donors who underwent PLDRH at Asan Medical Center in Seoul, Korea between November 2014 and December 2021. We reviewed donor and recipient demographics and anatomical characteristics of the donor grafts. Donor complications were classified and evaluated based on the Clavien-Dindo classification. The incidence of early donor complications within 30days of surgery was 0.9% (n = 3), with minor complications in 0.3% (n = 1) patients and major complications in 0.6% (n = 2). No biliary complications were observed and no late complications had been reported by 30days after surgery. The mean length of postoperative hospital stay was 7.2days. PLDRH was a safe and feasible surgical technique characterized by a low complication rate and short hospital stays. PLDRH has the potential to become the standard procedure for the retrieval of right liver grafts from living donors.

A-154 Non-standard body fluid validation of d-dimer analysis of organox liver perfusate to support clinical evaluations of donor livers prior to transplantation

Abstract Background Non-standard body fluid analysis is considered a challenge to laboratories since very few have been approved by the FDA for routine testing. As medical procedures evolve, the laboratory must balance the requirement to uphold regulatory standards while also supporting procedures that improve patient care. The LUMC Liver Transplant Team recently implemented the use of the FDA-approved OrganOx Metra normothermic machine perfusion instrument for maintaining donor livers under physiologic conditions prior to transplantation. The team mitigates risk for biliary complications associated with fibrin microthrombi by perfusing a combination of alteplase rTPA with fresh frozen plasma and monitoring the prevalence of fibrin through the release of D-dimers over the course of ex situ normothermic preservation. Liver perfusate is not an FDA-approved specimen type for the analysis of D-dimer and requires laboratory verification as a compatible specimen for analysis. Methods The D-dimer HS 500 assay was performed on an ACL TOP 750 analyzer. Carry-over studies evaluated activated partial thromboplastin time (aPTT) of a normal control (citrated plasma) specimen initially, and repeatedly in-between sets of D-dimer measurements of heparinized perfusate specimen. Recovery studies were performed by mixing liver perfusate with citrated plasma spiked with D-dimer in known ratios, allowing for the calculation of an expected value of D-dimer. Results Carry-over studies measuring aPTTs of normal plasma specimens provided %CVs of 1 and 3%. Recovery of D-dimer in seven sets of independent add-mixture series (three mixed specimen per set) was on average 105% with a range from 95 to 113% recovery. Conclusions Concern for cross-contamination of perfusate specimen containing heparin anticoagulant on analyzers used to evaluate routine coagulation testing was mitigated by the results of the carry-over study, which provided %CV within the manufacturer limit for intraday precision. Recovery studies evaluating matrix effect for the analysis of D-dimer on liver perfusate generated under the LUMC liver transplant protocol indicated that the matrix of the perfusate did not impact D-dimer analysis, as compared to the FDA-approved specimen type.

Technical Refinements to Reduce the Early Biliary Complication in Living Donor Liver Transplantation

BackgroundBiliary reconstruction is a key factor that affects biliary complication rates. Surgical experience plays a pivotal role, but continuous technical refinement is essential for enhancing biliary outcomes. This study aimed to evaluate the biliary outcomes of LDLTs in patients undergoing microsurgical biliary reconstruction with continual technical refinements. Materials and MethodsThis observational cohort study analyzed data was conducted from 2006 to 2022. Microsurgical biliary reconstruction was performed using various refinements, including selective biliary stent insertion, ipsilateral (anatomical) bile duct anastomosis, use of a figure-of-8 suture over the junction of the graft and recipient bile ducts, and centralization techniques for size discrepancies greater than 2 to 1. Comparison and evaluation of early BC within one year post transplant was performed. Results1780 patients (including 1563 adults and 217 paediatric patients) underwent microsurgical biliary reconstruction in LDLTs at KCGMH between 2006 and 2022. The donor grafts comprised 1109 right liver grafts and 671 left liver grafts. Of the grafts, 23.1% had multiple bile ducts and 16.1% had bile duct sizes less than 3 mm. Duct-to-duct anastomosis was performed in most cases 1417 (79.6%), while 363 (20.4%) Roux-en-Y hepaticojejunostomies (RY HJ) was performed. The overall early BCs rate was 10% and notable improvements were observed, decreasing from 10.35% between 2006 and 2021 to 6.5% by 2022. Early BS comprised the most part of 6.1% as compared to 2.7% one year after transplantation. Stent insertion in selected cases, ipsilateral anastomosis, and the figure-of-8 suture technique significantly reduced early BCs. Although centralization technique showed promising results, its effect was not statistically significant. ConclusionsContinual technical refinements in MBR can contribute to a substantial reduction in early BCs following LDLT, ultimately leading to improved patient outcomes.

Endoscopic Treatment of Biliary Complications of Hydatid Cysts of the Liver

Endoscopic Treatment of Biliary Complications of Hydatid Cysts of the Liver

Evaluating the yield of digital single operator cholangioscopy in posttransplant biliary strictures after unsuccessful guidewire placement with ERCP.

Strictures are the most common biliary complication after liver transplantation, and endoscopic retrograde cholangiopancreatography (ERCP) is considered the gold standard in its management. Failure to cross the biliary anastomosis requires a repeated attempt with ERCP, referral for percutaneous transhepatic cholangiography (PTC) or surgery. We present our experience with the digital single operator cholangioscope (D-SOC) in achieving guidewire access in a liver transplant cohort with difficult biliary strictures who have failed conventional ERCP methods. This was a retrospective study involving two adult liver transplant centers servicing the two most populated states in Australia. Deceased-donor liver transplant recipients undergoing D-SOC for biliary strictures who have failed conventional methods to achieve biliary access were included. Between July 2017 to April 2022, eighteen patients underwent D-SOC after failing to achieve guidewire placement through standard ERCP techniques. Thirteen out of eighteen (72%) had successful guidewire placement with index D-SOC. Five of eighteen patients (28%) had unsuccessful guidewire placement with D-SOC. In two of these patients, use of D-SOC informed further endoscopic management, with one avoiding PTC and the other avoiding surgery. Two of the five patients required PTC and one patient was left unstented. Three patients developed post D-SOC cholangitis. D-SOC is effective at achieving guidewire access in post-liver transplant patients who fail conventional ERCP techniques and should be considered in the treatment algorithm as a step before PTC and surgery.

Hepatic artery stenosis after pediatric liver transplantation: The potential role of conservative management

AimThis study aimed to investigate the outcomes and effectiveness of various treatment strategies in patients with hepatic artery stenosis (HAS) after pediatric liver transplantation (pLT). MethodsThis is a single center observational cohort study between January 1st, 2004 and August 1st, 2023, including pLT recipients aged <18 years. The primary outcome was graft and patient survival. The secondary outcomes included incidence of biliary complications, technical success of surgery or endovascular therapy (EVT), and changes in liver function. The cut-off for early and late HAS was 14 days after pLT. ResultsAmong a total of 327 pLT patients, 4 % (n = 13) developed HAS (n = 3 early; n = 10 late). Treatments included surgical revascularization for one early HAS, conservative management with anticoagulation for one early and four late HAS, and EVT for one early and six late HAS. Over a median follow-up of 28.2 months after the diagnosis of HAS, graft survival was 100 % and 83 % in early and late HAS groups, and patient survival reached 100 % in both groups. One graft loss occurred in the conservative group. Conversely, graft survival in the EVT group was 100 %. ConclusionThe long-term outcomes of HAS after pLT are excellent. Both EVT and conservative management exhibited high graft survival rates for late HAS, with EVT achieving high technical success.

Superselective ablative chemo-ethanol embolization for recurrent single hepatocellular carcinoma: a 6-month outcome analysis.

To evaluate the safety and effectiveness of superselective ablative chemo-ethanol embolization (SACE) for the treatment of patients with recurrent single hepatocellular carcinoma (rHCC). This retrospective study included 22 patients (19 men; median age, 63 years [range, 38-86]) with Child-Pugh class of A/ B/C (16/3/3) that underwent SACE between January and June 2023 for recurrent single HCCs measuring ≤5 cm in diameter using a mixture of 99% ethanol and ethiodized oil/doxorubicin emulsion. The primary endpoint was the 6-month tumor response, and the secondary endpoints were the 1-month tumor response and treatment-related safety. This study was approved by our institutional review board, and the requirement for informed consent was waived. SACE was successfully performed in 22 patients (95.2%). The complete response rates at 1-month and 6-month after treatment were 100.0% and 83.3%, respectively. At 6-month, local tumor progression occurred in one patient and intrahepatic distant metastasis was found in six patients (30.0%). No 6-month mortalities were reported. No adverse events greater than grade 2 or laboratory deteriorations were observed. Biliary complications or liver abscesses were not observed. SACE for a single rHCC was highly effective in achieving a favorable 6-month tumor response and showed acceptable adverse events. However, further prospective studies are required to verify these findings.

Biodegradable internal biliary stenting in orthotopic liver transplantation – A feasibility study

IntroductionBiliary complications remain a common cause of morbidity after liver transplantation and often require invasive interventions to manage. We aimed to assess the technical feasibility and safety of placement of a biodegradable stent across the biliary anastomosis at the time of liver transplantation in patients having a duct to duct biliary reconstruction. MethodsFor this prospective, single-arm, descriptive study, 10 consecutive patients undergoing whole graft, deceased donor, liver transplantation and duct-to-duct biliary tract reconstruction were enrolled and a biodegradable biliary stent was sutured into the bile duct across the anastomosis. ResultsIn all 10 patients it was technically feasible to place and secure the stent safely during the operation. After >6 months (median of 212 days) follow up, no patients had developed biliary anastomotic stricture. One patient had transient bile leak immediately post-operative that was managed conservatively. One patient required endoscopic intervention for non-anastomotic stricture development and biliary cast material that had resulted in stent dysfunction. DiscussionThe results of this study suggest surgical feasibility of placement of an absorbable biliary stent across the biliary anastomosis at the time of liver transplantation, as well as an acceptable safety profile. Further studies are required to confirm these safety and feasibility findings and to assess efficacy in reducing rates of biliary complications and the need for endoscopic intervention in the early post-transplant period.

Failure to Rescue Pediatric Recipients of Living Donor Liver Transplantation: A Single-Center Study of Technical Complications in 500 Primary Grafts.

The concept of failure to rescue (FTR) has been used to evaluate the quality of care in several surgical specialties but has not been well-studied after living donor liver transplantation (LDLT) in children. This study retrospectively reviewed 500 pediatric LDLT performed at a single center between 1993 and 2022. The recipient outcomes were assessed by means of patient and graft survival rates, retransplantation rates, and arterial/portal/biliary complication rates. Graft and patient losses secondary to these complications were calculated regarding FTR for patients (FTRp) and grafts (FTRg). Overall 1- and 5-year patient survival rates were 94.5% and 92.1%, respectively, the corresponding figures for graft survival being 92.7% and 89.8%. One-year hepatic artery complication rate was 3.6% (n = 18 cases), the respective rates for portal vein complications and biliary complications being 5.7% (n = 57) and 15.6% (n = 101). One-year FTRp rates for hepatic artery thrombosis, portal vein thrombosis, anastomotic biliary stricture, and intrahepatic biliary stricture were 28.6%, 9.4%, 3.6%, and 0%, respectively. The corresponding FTRg rates being 21.4%, 6.3%, 0%, and 36.4%. Such novel analytical method may offer valuable insights for optimizing quality of care in pediatric LDLT.

Management of biliary complications after LDLT.

Biliary complications (BC) in the recipient continue to be an as yet, unresolved issue following living donor liver transplantation (LDLT). Bile leaks (BL) and biliary anastomotic strictures (BAS) are the most common BCs, with the latter contributing to close to 80%. With increasing expertise, endoscopic treatment with endoscopic retrograde cholangiography (ERC) [the first-line treatment] and percutaneous transhepatic cholangiography (PTC) with percutaneous transhepatic biliary drainage (PTBD) alone or in combination with ERC lead to successful management in a majority of these cases. However, prediction of difficulty of endoscopic success in biliary strictures, optimal duration of indwelling stents and their planned removal, management options in high-grade strictures (HGS) and the long-term outcome of patients requiring intervention for BC's are still unanswered questions in this setting. This review will try to summarise pertinent issues, novel insights and finally propose basic principles to be adhered to when dealing with the gamut of possible biliary complications after LDLT.

Digital single-operator cholangioscopy in the evaluation of biliary strictures after liver transplantation.

Biliary tract complications after orthotopic liver transplantation (OLT) are frequently reported. The diagnosis and management of these complications have become increasingly crucial, with digital single operator cholangioscopy (DSOC) emerging as an essential tool. We describe the approach to biliary complications using DSOC in 5 patients post-OLT. Inflammatory and ischemic stricture, a stricture secondary to post-transplant lymphoproliferative disease, and common bile duct lithiasis were the main findings. The exceptional image quality provided by the DSCO allowed us to precisely characterize strictures, observe epithelial changes, and identify obstructions due to bile casts that remained undetectable through ERCP. DSOC is a viable method for evaluating post-OLT biliary complications, offering alternative therapies beyond ERCP, thus improving care precision and outcomes.

Long-term Outcomes Following Colectomy and Liver Transplantation for Inflammatory Bowel Disease with Primary Sclerosing Cholangitis.

To investigate the long-term outcomes of patients with combined primary sclerosing cholangitis/inflammatory bowel disease (PSC-IBD) undergoing both liver transplantation (LT) and total abdominal colectomy (TAC). The fraction of patients with PSC-IBD that require both LT and TAC is small, thereby limiting significant conclusions regarding long-term outcomes. Adult and pediatric patients from nine centers from the US IBD Surgery Collaborative who underwent staged LT and TAC for PSC-IBD were included. Long-term outcomes, including survival, were assessed. Among 127 patients, 66 underwent TAC-before-LT, with a median time from TAC to LT of 7.9 yrs, while 61 underwent LT-before-TAC, with a median time from LT to TAC of 4.4 years. Median patient survival post TAC was significantly worse in those undergoing LT-before-TAC (16.0 yrs vs. 42.6 yrs, P=0.007), while post LT survival was not impacted by the order of TAC and LT (21.6 yrs vs. 22.0 yrs, P=0.81). Patients undergoing TAC for medically refractory disease had a higher incidence of recurrent PSC (rPSC) (P=0.02) and biliary complications (0.09) compared to those undergoing TAC for oncologic indications. Definitive TAC reconstruction with either end ileostomy or ileal-pouch anal anastomosis (IPAA) did not impact post-LT or post-TAC outcomes. Long term survival in PSC-IBD was contingent upon progression to LT and was not impacted by the need for TAC. PSC-IBD patients undergoing TAC for medically refractory disease had a higher incidence of rPSC and biliary complications. The use of IPAA in PSC-IBD was a viable alternative to end ileostomy.

Comparison of Biliary Complications Between Living and Deceased Donor Liver Transplantations: A Systematic Review and Meta-analysis.

To understand if the risk of biliary complications is higher with living donor liver transplantation (LDLT) compared to deceased donor liver transplantation (DDLT), the present meta-analysis was conducted to analyze the differences between these two types of liver transplantations.Three databases were searched from inception to September 2023 for comparative studies reporting biliary complications with LDLT and DDLT. Odds ratios (OR) with 95% confidence intervals were calculated for all the dichotomous outcomes.Twenty-eight studies were included in the final analysis. LDLT was associated with a significantly higher incidence of biliary complications than DDLT (OR 1.96, 95% CI: 1.56-2.47). However, on subgroup analysis, only studies published in or before 2014 reported a higher incidence of biliary complications with LDLT, but not with studies published after 2014. An analysis of individual adverse events showed that LDLT was associated with a higher incidence of both bile leak (OR 3.38, 95% CI: 2.52-4.53) and biliary stricture (OR 1.75, 95% CI: 1.20-2.55).LDLT was associated with a higher incidence of overall biliary complications, including bile leak and biliary stricture. With advances in surgical techniques, there has been a reduction in the risk of biliary complications.

ThP4.7 - The outcome of a single stage Laparoendoscopic rendezvous ERCP and laparoscopic cholecystectomy for cholecystocholedocholithiasis in a DGH

Abstract Cholecystocholedocholithiasis is managed surgically by laparoscopic cholecystectomy (LC) and simultaneous common bile duct (CBD) exploration or by preoperative Endoscopic Retrograde Cholangiopancreatography (ERCP) followed by LC. Rendezvous ERCP (RERCP) is an innovative laparoendoscopic technique combining LCs and ERCPs. As a single staged procedure, a LC is performed and selective canulisation of the CBD is aided by laparoscopic transcystic placement of a guide-wire into the duodenum. We present a case series of RERCPs within a DGH. This case series collected retrospective data (2014-2023) involving 33 patients, of which 21 underwent RERCP. Preoperative variables included age, indication, gender, ASA grade, Charlson comorbidity index (CCI), frailty score and indication. Postoperative variables analysed were operating time, complications, 30-day re-admission rates and length of stay in hospital (LOSH). Of the 21 patients who underwent a RERCP, 76% (n=16) were female. The average age was 60±17years and 59% (n=13) of all procedures were elective. The ASA range was I to III, average CCI and frailty score were 2.4±1.9 and 0.1±0.4 respectively. 52% (n=11) of patients had a previous failed ERCP. The average operating time was 152±39mins. The average LOSH was 3.5±2.8days and 2.5±2.1days following the RERCP. Biliary (including pancreatitis) and non-biliary complications were 9.5% (n=2) and 9.5% (n=2) respectively. The 30-day readmission rate was 9.5% (n=2). There was no significant difference in the operating time (p=0.16), LOSH (p=0.19) complication (p=0.13) and readmission rates (p=0.50) between emergencies and elective procedures. RERCP remains a valuable option when managing cholecystocholedocholithiasis in emergency and elective settings.