Complicated Gallstone Research Articles

Gall stones in metabolic syndrome- addressing the risks in obese individuals

Significant research has been dedicated in recent years to elucidating the pathophysiologic mechanisms behind gallstone development, but the epidemiology of gallstone disease has received comparatively little focus. Numerous studies have emphasized the correlation between metabolic syndrome and gallstones. In this study, we found a positive correlation between complicated gall stones and metabolic syndrome. Hence, screening of obese patient or those with PCOS/uncontrolled diabetes, should be introduced in the protocol for facilitate early diagnosis of gall stones.

Assessment of routine pre-operative group and save testing in patients undergoing cholecystectomy: a retrospective cohort study.

Routine group and save (G&S) testing is frequently performed prior to cholecystectomy, despite growing evidence that a targeted approach is safe and avoids unnecessary investigations. This retrospective cohort study explored frequency of testing in our unit, rates of peri-operative blood transfusion and pre-operative risk factors for requiring transfusion. Health records of 453 consecutive adults who underwent cholecystectomy in a UK NHS trust were reviewed for blood transfusion up to 30 days post-operatively. We compared the need for transfusion against patient demographics, indication and urgency of surgery, and the number of prior emergency hospital attendances with gallstone complications. Logistic regression determined whether prior attendances with complications of gallstones independently predicted the need for transfusion. Peri-operative blood transfusions within 30 days of operation occurred in 1.1% of cases, with no requirement for uncrossmatched blood. Patients who received a blood transfusion tended to have higher American Society of Anesthesiologists (ASA) grades ( p = 0.017), were more likely to have an underlying primary haematological malignancy (20.0% vs. 0.2%; p = 0.022) and prior emergency hospital attendances with gallstone complications (median 4 vs. 1; p < 0.001). Logistic regression showed each prior emergency attendance was associated with 4.6-fold odds of transfusion ( p = 0.019). Receiver operating characteristic curve analysis showed an area under the curve of 0.92. Three or more attendances predicted need for transfusion with 60.0% sensitivity and 98.0% specificity. 74% of patients had at least one G&S sample taken pre-operatively, costing the trust approximately £3,800 per year in materials. The findings of this study suggest that pre-operative G&S testing prior to cholecystectomy is not routinely required. Increased frequency of prior emergency hospital attendances with gallstone complications and co-morbidities associated with coagulopathies were pre-operative risk factors for post-operative blood transfusion. More selective testing could provide large financial savings for health institutions without compromising patient safety.

Is the trocar through which the gallbladder is removed during cholecystectomy important for potential complications?

Objective: Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallstone disease and complications can develop at trocar sites following laparoscopic cholecystectomy. This study aims to evaluate the impact of extracting the gallbladder through either the umbilical or epigastric ports during laparoscopic cholecystectomy on the complications observed after gallbladder extraction. Methods: Symptomatic cholelithiasis patients who had four port laparoscopic cholecystectomy included to the study. Individuals were divided into two groups based on gallbladder removal site: umbilical or epigastric. Medical records were reviewed for post-surgical complications within 30 days and incisional hernias within one year. The age, gender, operation duration, BMI and the largest stone dimentions of the patients were also noted. Results: A total of 112 patients were included in the study, with 45 patients in the umbilical group and 67 patients in the epigastric group. No significant differences were observed in age, gender, body mass index and stone dimentions between groups. Port site hernia and port site infection developed more frequently but not significantly in umblical group. When examined the stone dimention and BMI based on the presence of a port site hernia and port site infection, BMI and stone dimention were significantly higher in port site infection and hernia patients. Conclusion: Using umbilical port for removing gallbladder, carried a higher risk of infection and hernia development. Additionally, regardless of which trocar is used, patients with a high BMI and large stone dimensions have a higher risk of port site infection and hernia. Patients should be informed about these risks during the preoperative period.

WP7.9 - Evaluation of outcomes of early laparoscopic cholecystectomy for acute gallstone disease using Traffic Light Booking system

Abstract Introduction Delayed cholecystectomy leads to recurrent admissions with potential increased preoperative, operative, and postoperative complications. Aim To evaluate the outcomes of early laparoscopic cholecystectomy using traffic light booking system. Methods A quality improvement early gallbladder service was designed using the weighted scores of patients’ demographics, BMI, comorbidities, LFTs, imaging findings, confirmed diagnosis and associated gallstone complications. The scores were stratified into traffic light system colours of green (0-3), amber (4-6) and red (&amp;gt;7) to predict the operative difficulty and allocated operative time. Early cholecystectomy was performed within 6 weeks of the onset of symptoms. Operative difficulty grading use was by Nassar et al. Prospectively data was analysed using SPSS to present the outcomes. Results 207 patients had early cholecystectomy from February 2022 to January 2024. Median age was 50.5 years and 71.5% were females. Diagnoses were 60 biliary colic, 102 acute cholecystitis, 41 pancreatitis and 4 cholecystitis with biliary obstruction. Traffic light scores were 114 green, 76 amber and 17 red while operative difficulty grading was 44 mild, 73 moderate, 54 severe and 36 extreme difficulties. Median time to surgery was 21 (21-42) days and median operative time was 75 (25-205) minutes. 13.5% of the patients were operated at the index admission, 67.1% as day cases, 20.3% stayed overnight and 12.6% as inpatient stays. None were converted to open but four procedures were abandoned. Complication and readmission rates were 4.8% and 5.3% respectively with one patient returning to theatre. Conclusion Early laparoscopic cholecystectomy service can be safely delivered with the majority done as day cases.

Clinical Evaluation of Primary Suturing of Normal-Diameter Common Bile Ducts After Microincision of Cystic Duct Confluence for Stone Removal.

In patients with gallstones complicated by common bile duct (CBD) stones, both normal and dilated common bile ducts have been reported. The goal of this study was to investigate the efficacy and safety of primary suturing after microincision of the cystic duct confluence in treating these patients. Between July 2018 and December 2021, 104 patients were admitted to the Department of General Surgery at Guannan County People's Hospital with gallstone complications, and their records were reviewed retrospectively. The patients were divided into 2 groups: normal CBD group (n=70, CBD diameter: 6.0 to 8.0mm) and dilated CBD group (n=34, CBD diameter: >8.0mm). In these 104 patients, there were 75 cases of CBD stones with acute cholangitis, 12 cases of CBD stones without cholangitis, and 17 cases of mild biliary pancreatitis with CBD stones (including 2 cases of biliary pancreatitis with cholangitis). Among all patients, there were 37 cases with jaundice, 67 cases without jaundice, and 5 cases of emergency surgery. All patients underwent microincision of the cystic duct confluence followed by primary suturing. Both groups were compared on a variety of general and perioperative indicators. All patients underwent laparoscopy combined with choledochoscopy; there were no cases of biliary tract injury or conversion to laparotomy. There was no statistically significant difference in operation duration ( P =0.286), blood loss ( P =0.06), length of stay ( P =0.821), and time to drainage tube removal ( P =0.096) between the 2 groups. Microincision of the cystic duct confluence, followed by a primary suture, is a safe and effective treatment for CBD stones in patients with a normal CBD diameter, as determined by preoperative imaging.

Symptomatic uncomplicated gallstone disease is associated with a high short-term risk of gallstone-related complications: a contemporary cohort study

Background The natural history of symptomatic uncomplicated gallstone disease is largely unknown. We examined the risk of progressing from symptomatic uncomplicated to complicated gallstone disease in a large regional cohort of patients, where disruptions in elective surgical capacities have led to the indefinite postponement of surgery for benign conditions, including cholecystectomies. Methods Patients with radiologically diagnosed incident symptomatic and uncomplicated gallstone disease were identified from outpatient clinics and emergency departments on the Island of Funen, Denmark. The absolute risk of complications (cholecystitis, cholangitis, pancreatitis, acute cholecystectomy for unremitting pain) was calculated using death and elective cholecystectomies as competing risks using the Aalen-Johansen method. Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs) of gallstone complications associated with patient and gallstone characteristics. Results Two hundred eighty-six patients diagnosed with incident symptomatic, uncomplicated gallstone disease from 1 January 2020 to 1 July 2023 were identified. During 79,170 person-years of observation, 176 (61.5%) patients developed a gallstone-related complication. The 6-, 12- and 24-month risk of developing gallstone-related complications were 36%, 55% and 81%. The risk of developing complications related to common bile duct stones was lowest with larger stones (aHR per millimeter increase = 0.89 (0.82–0.97), p < 0.01), while no covariates were statistically significantly associated with the risk of cholecystitis. Eighty-five (30%) patients underwent elective laparoscopic cholecystectomy, with one patient (1.2%) developing a gallstone-related complication afterward. Conclusions The risk of developing complications to symptomatic gallstones in a general Scandinavian population is high, and prophylactic cholecystectomy should be considered.

The Multifaceted Impact of Gallstones: Understanding Complications and Management Strategies.

Gallstones, or cholelithiasis, represent a prevalent gastrointestinal disorder characterized by the formation of calculi within the gallbladder. This review aims to provide a comprehensive analysis of the complications associated with gallstones, with a focus on their pathophysiology, clinical manifestations, diagnostic methodologies, and management strategies. Gallstone-related complications encompass a broad spectrum, including biliary colic, acute cholecystitis, choledocholithiasis, acute pancreatitis, and cholangitis. The pathogenesis of these complications primarily involves biliary obstruction and subsequent infection, leading to significant morbidity and potential mortality. Diagnostic evaluation of gallstone complications employs various imaging techniques, such as ultrasonography, magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP), each with distinct advantages and limitations. Therapeutic approaches are discussed, ranging from conservative management with pharmacotherapy and bile acid dissolution agents to interventional procedures like extracorporeal shock wave lithotripsy (ESWL) and percutaneous cholecystostomy. Surgical management, particularly laparoscopic cholecystectomy, remains the gold standard for definitive treatment. Additionally, advancements in endoscopic techniques, including endoscopic sphincterotomy(EST) and cholangioscopy, are highlighted. This review synthesizes current research findings and clinical guidelines, aiming to enhance the understanding and management of gallstone-related complications among healthcare professionals, thereby improving patient outcomes and reducing the burden of this common ailment.

Assessment of routine pre-operative group and save testing in patients undergoing cholecystectomy: a retrospective cohort study

Background Routine group and save (G&amp;S) testing is frequently performed prior to cholecystectomy, despite growing evidence that a targeted approach is safe and avoids unnecessary investigations. This retrospective cohort study explored frequency of testing in our unit, and rates of and independent pre-operative risk factors for peri-operative blood transfusion. Methods Health records of 453 consecutive adults who underwent cholecystectomy in a UK NHS trust were reviewed for blood transfusion up to 30 days post-operatively. We compared the need for transfusion against patient demographics, indication and urgency of surgery, and the number of prior emergency hospital attendances with gallstone complications. Logistic regression determined whether prior attendances with complications of gallstones independently predicted the need for transfusion. Results Peri-operative blood transfusions within 30 days of operation occurred in 1.1% of cases, with no requirement for uncrossmatched blood. Patients who received a blood transfusion tended to have higher American Society of Anesthesiologists (ASA) grades (p&lt;0.001), were more likely to have an underlying primary haematological malignancy (20.0% vs. 0.2%; p&lt;0.001) and prior emergency hospital attendances with gallstone complications (median 4 vs. 1; p&lt;0.001). Logistic regression showed each prior emergency attendance was associated with 4.6-fold odds of transfusion (p=0.019). Receiver operating characteristic curve analysis showed an area under the curve of 0.92. Three or more attendances predicted need for transfusion with 60.0% sensitivity and 98.0% specificity. Seventy-four percent had at least one G&amp;S sample taken pre-operatively, costing the trust approximately £3,800 per year in materials. Conclusions Pre-operative G&amp;S testing prior to cholecystectomy may not be routinely required. Increased frequency of prior emergency hospital attendances with gallstone complications and co-morbidities associated with coagulopathies were pre-operative risk factors for post-operative blood transfusion. More selective testing could provide large financial savings for health institutions without compromising patient safety.

Surgeon-Performed Percutaneous Endoscopic Biliary Lithectomy: Description of a Novel Technique and Initial Results.

Introduction: Percutaneous endoscopic biliary lithectomy (PEBL) can be performed through preexisting drain tracts, offering ductal clearance and definitive management for patients with complicated gallstone disease unable to undergo conventional therapy. The technique has not been widely adopted by general surgeons. Herein, we describe our technique with surgeon-performed PEBL and present initial results. Materials and Methods: A single institutional retrospective review of the electronic medical record was performed for patients who underwent percutaneous choledochoscopy between February 2019 and November 2020. All operations were performed by 1 of 2 board-certified general surgeons with fellowship training in surgical endoscopy. Preoperative, operative, and postoperative variables were analyzed using descriptive statistics. Results: Thirteen patients underwent PEBL. Seventeen total procedures were performed; 4 patients underwent repeat intervention. The diagnoses leading to PEBL were: cholelithiasis (8), choledocholithiasis (4), and recurrent pancreatitis (1). Complete ductal clearance was achieved in 9 patients (69.2%) during the initial procedure. The remaining 4 patients (30.8%) underwent repeat PEBL, at which point complete ductal clearance was then achieved. The percutaneous drain was removed at the time of final procedure in 5 patients (38.5%) or within 5 weeks in the remaining 8 (61.5%). No intraoperative complications occurred, and no pancreatic or biliary postoperative complications or recurrences were noted with a mean follow-up of 279 ± 240 days. Conclusion: Surgeon-performed PEBL is a safe and effective method of achieving biliary ductal clearance. The technique is readily achieved following basic endoscopic and fluoroscopic principles and should be understood by all physicians managing gallstone disease.

O196: Gallbladder Necrosis: Predictive Factors in Patients Undergoing Emergent Cholecystectomy

Abstract Introduction Gallstones are present in up to 25% of the general population and approximately 2% of these become symptomatic. Gallbladder necrosis is a complication of gallstones associated with higher risks of morbidity and mortality. Identification of risk factors which portend to gallbladder necrosis is key in prioritising investigation and treatment for higher risk patients. Method A retrospective review of all patients undergoing emergency cholecystectomy in a tertiary hospital over a 2-year period was performed. Gallbladder necrosis was diagnosed on histopathological examination of operative specimens. Multivariable logistic regression was performed to determine risk factors for gallbladder necrosis. Results 152 patients underwent acute cholecystectomy and 44 (29%) had proven gallbladder necrosis. Multivariable model demonstrated that white cell count (WCC) (OR 1.122, 95% CI 1.031-1.221, p=0.007), C-reactive protein (CRP) (OR 1.004, 95% CI 1.001-1.008, p=0.022) and smoking status (OR 5.724, 95% CI 1.323-24.754, p=0.020) were independently predictive of gallbladder necrosis. Notably, advancing age, elevated BMI, diabetes mellitus or ASA grade were not found to be associated with developing necrosis. Conclusion Patients at risk of gallbladder necrosis include those with higher WCC, CRP and active smokers. Given the increased potential complications, these risk factors should be identified early in the management of those admitted with gallstone disease to ensure such patients receive aggressive medical therapy alongside timely and guided surgical intervention.

Comparative study of morbidity of open cholecystectomy vs laparoscopic cholecystectomy in complicated gall stone disease.

Objective: To evaluate the resist of minimally invasive surgery i.e. laparoscopic cholecystectomy versus open cholecystectomy in cases with complex gallstone diseases. Study Design: Prospective study. Setting: North Surgical Ward, Mayo Hospital Lahore. Period: 11th July 2020 till 10th January 2021. Material &amp; Methods: A total of 372 patient’s fulfilling the criterion was included for study in group-A Laparoscopic cholecystectomy was done. In group B open cholecystectomy was done which includes 86 patients. The entire patient received injection Ketorolac 30 mg i.e. 8 hourly and postoperative injection NeIbufin 6 mg i.v.12hourIy as standard in all patients and Post-operative pain was assessed Visual analogy scale after 24 hours. Results: The mean age of patients in open group was 41.28 ± 13.75 years and in Laparoscopic group was 43.46 ± 13.90 years. In Open group there were 80(43%) male and 106(57%) female cases while in Laparoscopic group there were 65(34.9%) male and 121(65.1%) female cases. The mean hospital stay was statistically shorter in Laparoscopic group (3.80 ± 1.37 days) as compared to Open group (5.12 ± 1.58 days), p-value &lt;0.001. In open group 77(41.4%) cases had post-operative pain and in Laparoscopic group 27(14.5%) cases had post-operative pain. The post-operative pain was statistically higher in open groups, p-value &lt; 0.001. Conclusion: Laparoscopic is an ideal treatment option in terms of less pain and shorter duration of hospital stay as compared to open cholecystectomy for patients with complicated gallstone disease.

Bouveret’s syndrome from 2 large gallstones — a rare complication of gallstones

Bouveret’s syndrome from 2 large gallstones — a rare complication of gallstones

Concomitant Bouveret’s syndrome and gallstone ileus: case report and literature review

Gallstone ileus and Bouveret's syndrome are rare gallstone complications; therefore, their combination is even rarer. The delay of diagnosis is associated with high rates of morbidity and mortality. We reported a 65-year-old woman presented with a three-day history of epigastric and lower right abdominal pain, nausea, and vomiting. A radiopaque shadow was noted on an abdominal X-ray in both the right upper and lower quadrants. In addition to the cholecysto-duodenal fistula, the CT abdomen revealed a combined ileal gallstone ileus with small bowel dilatation and stone in the second portion of the duodenum (Bouveret's syndrome). Initial attempts to extract duodenal stones endoscopically were unsuccessful. Therefore, the patient underwent an exploratory laparotomy and removal of both ileal and duodenal stones. The patient had an uneventful postoperative course. Serious complications include obstruction of the gastric outlet or the small intestine due to gallstone ileus, Bouveret's syndrome, or both. Despite the high failure rate, endoscopic extraction of the stone alone or in combination with lithotripsy is the standard treatment for Bouveret's syndrome. Furthermore, surgical intervention is the standard treatment for gallstone ileus. Gallstone ileus and Bouveret's syndrome remain diagnostic and therapeutic challenges, which necessitate an immediate multidisciplinary approach to prevent substantial morbidity and mortality. Further reports or larger-scale studies are encouraged.

Endogenous hepatic toxicity and oxidative stress in the complications of gallstones associated with cholestatic jaundice

Introduction. Cholestatic jaundice installed in gallstones is considered a multifactorial pathogenetic process. The correlation of endogenous hepatic intoxication with the reaction of the pro- and antioxidant system, characteristic of various complications of gallstones associated with cholestatic jaundice, remains an undefined subject. Material and methods. The study included the investigation of 105 patients with complicated gallstones and associated cholestatic jaundice, and the control group – 35 patients with uncomplicated gallstones. The age of the patients varied between 51 and 72 years, with an F/M ratio of 3/1. Results. The degree of endotoxemia, assessed at hospitalization by peptides with average mass values, was consistent with the inflammation present in groups 2 and 3, reporting a statistically significant difference compared to the control group [p c/2 &lt; 0.001 (t = 11.1); p c/3 &lt; 0.001 (t = 11.07)]. DAM, as the final product of lipid peroxidation, evaluated at hospitalization, shows double marked values in all groups compared to the control group [p &lt; 0.001 (t = 10.7); (t = 10.9); (t = 16.5)]. The antioxidant activity, assessed at hospitalization, shows a statistically significant decrease in superoxide dismutase values [p &lt; 0.001 (t = 6.4); (t = 4.1); (t = 5.7)], as well as catalase [p &lt; 0.001 (t = 6.7); (t = 5.6); (t = 7.2)] in all groups, by 30-40% compared to the control group. Conclusions. In established cholestatic jaundice, there is an obvious activation of lipoperoxidation processes, contributing to the increase of endogenous intoxication and early suppression of antioxidant activity. There is a direct relationship between the increase in prooxidant activity and the level of endogenous intoxication in all complications of gallstones associated with cholestatic jaundice, but it is more elevated in infectious complications, indicating a need for an early approach.

Early versus delayed cholecystectomy in biliary pancreatitis: Experience from a Local Acute Care Surgery Unit in Saudi Arabia.

Biliary pancreatitis is a common complication of gallstones. Although most patients experience mild disease, around 20% may develop severe pancreatitis with an increased risk of serious complications during recurrent attacks. The objective of our study is to compare the surgical outcomes and length of stay for early versus delayed cholecystectomy, performed within the same admission, for mild pancreatitis in a Saudi tertiary center with an established Acute Care Surgey Unit. This retrospective cohort study included all patients who underwent cholecystectomy during the index admission for biliary pancreatitis between January 2017 and January 2020. Surgical outcomes and hospital length of stay were collected and analyzed to assess overall outcomes for early and delayed cholecystectomy groups. The early group was defined as surgery performed within 72 hours of presentation. Eighty-six patients were included and allocated to the early and delayed cholecystectomy groups. The median length of hospital stay was significantly shorter in the early cholecystectomy group (4 days, IQR 3-5) compared to the delayed group (7 days, IQR 6-9) (P < .001). There was no significant difference in operative time and postoperative complications. Early cholecystectomy for mild biliary pancreatitis appears safe and feasible and may result in a shorter hospital stay.

OGBN P35 The effect of social deprivation in patient outcomes following cholecystectomy

Abstract Background Socio economic status (SES) has shown to impact patient outcomes in different types of cancer. Socio economically deprived populations experience severe as well as complicated gall stone diseases more frequently in comparison with their affluent counterparts (doi: 10.1089/heq.2022.0063). However, the impact of SES on the presentation and outcomes of gallstone disease(GSD) in deprived population is not well studied. Therefore, a study was set up to assess the impact of deprivation in patients presenting with GSD. Methods A retrospective observational study of cholecystectomies in adults in our trust from August 2022 to December 2022 was performed. Patients were assigned into Affluent(AF) and Non-Affluent(NA) groups based on the Index of Multiple Deprivation (https://data-communities.opendata.arcgis.com/datasets/communities::indices-of-multiple-deprivation-imd-2019-1/explore). Data was collected using MS Excel and analysed using IBM SPSS statistics ver 27. Results 100 patients were included from August to December 2022. Male female ratio was 1:3. The five most deprived deciles (NA) had 46 and the five least deprived deciles (AF) had 54 patients. Median age in years was 48 and 52.5 respectively (p = 0.10). The NA deciles had 37 patients referred via the emergency department (ED) and 9 via GP. AF deciles had 34 referrals via ED and 20 via GP (p=0.05). No statistically significant difference was observed in Charlson’s index (p=0.53), operative time (p=0.58) and length of stay (p=0.74) between the groups. There were no conversions to open. Conclusions A higher ratio of patients came via GP referrals in the affluent deciles whereas more patients were referred via the ED in the non affluent deciles. However, there was no statistically significant difference in time to surgery and outcomes between these two groups.

Effect of the COVID-19 pandemic on the care for acute cholecystitis: a Swedish multicentre retrospective cohort study

ObjectivesThe present study aimed to investigate if and how the panorama of acute cholecystitis changed in 2020 in Sweden. Seven aspects were identified, the incidence of cholecystitis, the Tokyo grade,...

Acute cholecystitis as a complication of diverting loop ileostomy: A case series and narrative review

Introduction: Diverting ileostomy is increasingly utilized in modern colorectal surgery for the management of colorectal cancer and inflammatory bowel disease (IBD) among other bowel pathologies. Cholelithiasis has known associations with ileostomy and IBD, potentially caused by changes to enterohepatic circulation and cholesterol absorption in the gallbladder. However, cases of cholecystitis following ileostomy have not been reported across the literature. Case Series: We present three cases of cholecystitis following diverting loop ileostomy in a 56-year-old female, 74-year-old female, and 73-year-old female. A digital literature search was conducted on databases PubMed and EMBASE in February 2023 covering literature from 1974 to 2023 to identify any further cases; however, none were identified. To our knowledge, these are the first reported cases of cholecystitis following ileostomy. Conclusion: We believe these three cases highlight that developing symptomatic gallstones following diverting ileostomy occurs, and patients should be carefully counseled of the risks preoperatively, and be educated of gallstone-related symptoms to enable early engagement of upper gastrointestinal surgeons for treatment. Additionally, we recommend preoperative gallbladder imaging and close monitoring prior to and after ileostomy formation for development of gallstone complications. Ultimately, this case series and narrative review lay the groundwork for further research investigating any causality between diverting loop ileostomy formation and development of complications of gallstone disease.

Cholecystectomy and ERCP in pregnancy: a nationwide register-based study.

The objective was to examine the outcomes of cholecystectomy and endoscopic retrograde cholangiopancreatography (ERCP) during pregnancy and compare these outcomes with those in nonpregnant women of fertile age. Although both laparoscopic cholecystectomy and ERCP are considered safe and feasible in pregnant patients, there is still concern and uncertainty regarding gallstone intervention during pregnancy. This study aimed to investigate outcomes in pregnant patients compared to outcomes in nonpregnant patients. Data on all female patients aged 18-45 years were retrieved from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography. The patients were divided into groups according to intervention: cholecystectomy, ERCP, or a combination thereof. Differences between pregnant and nonpregnant patients were analyzed. A total of 21328 patients were included, with 291 cholecystectomy and 63 ERCP procedures performed in pregnant patients. At the 30-day follow-up, more complications after cholecystectomy were registered for pregnant patients. However, pregnancy was not a significant risk factor for adverse events when adjusting for previous complicated gallstone disease, intraoperative complications, emergency surgery, and common bile duct stones. There were no differences in outcomes when comparing cholecystectomy among the different trimesters. ERCP had no significant effect on outcomes at the 30-day follow-up. Cholecystectomy, ERCP, and combinations thereof are safe during pregnancy.

407 Robotic Assisted Cholecystectomy and Common Bile Duct Exploration for Single Stage Management of Complex Gallstone Disease

Abstract Aim Laparoscopic cholecystectomy and common bile duct exploration (LC-CBDE) is an alternative to endoscopic retrograde cholangiopancreatography (ERCP) for treatment of choledocholithiasis. The ‘Achilles heel’ of LC-CBDE is the choledochotomy incision and closure following duct clearance. Robotic assisted surgery (RAS) aspires to overcome these technical challenges by providing improved views (3D enhancement) and articulated instruments potentially improving surgical precision. We aim to scrutinise the outcomes of an early series of robotic assisted cholecystectomy and common bile duct exploration (RC-CBDE) cases performed at our institution. Method Retrospective analysis from a specialist benign pancreatico-biliary unit in the United Kingdom was undertaken from April 2022 – December 2022 inclusive. All patients who underwent RC-CBDE for complicated gallstone disease were included. Collated data included patient demographics, perioperative investigations, intraoperative approach, and postoperative outcomes. Results 10 patients were identified. Median (IQR) age was 51 (33 – 66) years. Median (IQR) BMI was 26 (21 – 32) kg/m2. Median (IQR) Charlson Co-morbidity Index (CCI) was 1 (0 – 4). 4 patients were operated on during the acute presentation, with median (IQR) bilirubin 51 (34 – 252.5). Median (IQR) operative time was 176 (124 – 222) minutes. Median (IQR) post-operative length of stay was 4 (1 – 5) days. One patient required reintervention for port site hernia repair from drain site. Conclusions RC-CBDE is a safe and effective treatment for choledocholithiasis with equivocal outcomes to LC-CBDE. Benefits of RAS include enhanced views and ergonomics aiding precise closure of choledochotomy, which may both reduce complications and promote wider uptake of common bile duct exploration – a previously underutilised, technically-challenging operative procedure.