Cystic Duct Research Articles

Chyle leakage after laparoscopic cholecystectomy in a patient with duplicated cystic ducts: A case report and literature review.

Laparoscopic cholecystectomy (LC) is widely performed as a standard treatment for cholelithiasis, and chyle leakage after LC has rarely been reported. Duplicated cystic ducts draining a single gallbladder is an extraordinarily rare variation. We presented a case of chyle leakage after LC in a 53-year-old female with a rare variation of duplicated cystic ducts. Chyle leakage and duplicated cystic ducts. Conservative treatment including lipid intake and constant drainage. After 24 days of conservative treatment, the patient recovered and had no further troubles during the 3-month follow-up. There may be a potential relationship between anatomic variants of the extrahepatic bile ducts and those of the lymphatic system. When anatomic variations of the extrahepatic bile ducts are encountered, vigilance for lymphatic system injuries is as important as vigilance for bile duct injuries. Conservative therapy is the first choice for postoperative chyle leakage, and surgical intervention should be considered in cases with high-volume chyle leakage.

Feasibility of open cholangioscopy with disposable flexible endoscopes.

To determine the feasibility of open cholangioscopy using disposable flexible endoscopes in canine cadavers and describe the surgical approach. Ex vivo experimental cadaveric study. Eight canine cadavers. Cadavers ranging from 5.8 to 43.8 kg underwent open transcholecystic cholangioscopy using a disposable flexible endoscope with a 3.8 mm outer diameter and 1.2 mm working channel and the surgical approach was described. The most distal anatomical region of the biliary tree towards the duodenal papilla that was visualized with the endoscope was recorded in each cadaver. A 2.7 mm rigid endoscope and a 1.9 mm flexible endoscope were also trialed and findings recorded. Endoscopic tools were trialed and their usage recorded. The disposable flexible endoscope was feasible for visualization of the junction of the common bile duct, cystic duct, and hepatic ducts in all eight dogs. Cholangioscopy using a 2.7 mm rigid endoscope did not provide further distal visualization. The 1.9 mm flexible endoscope was able to traverse down to the level of the major duodenal papilla in a 43.8 kg cadaver. Use of certain endoscopic tools can be considered through the disposable flexible endoscope although fluid instillation was affected. A 3.8 mm disposable flexible endoscope could be placed through an open transcholecystic approach to provide intraluminal endoscopic evaluation up to the level of the junction of the common bile duct, cystic duct, and hepatic ducts in dogs without cholecystic disease. Open transcholecystic cholangioscopy with a disposable flexible endoscope could provide a low-cost diagnostic and therapeutic tool in cases of obstructive biliary disease up to the level of the common bile duct.

S4003 Cystic Duct Take Off From the Right Main Hepatic Duct: Case of an Interesting Anatomic Variant

S4003 Cystic Duct Take Off From the Right Main Hepatic Duct: Case of an Interesting Anatomic Variant

Clinical and patient-reported outcomes following subtotal cholecystectomy: 10-year single-institution experience

ObjectiveSubtotal cholecystectomy provides a safe, bail-out alternative for difficult gallbladders. However, long-term outcomes comparing fenestrating and reconstituting subtotal cholecystectomy subtypes remain underexplored. MethodsThis retrospective cohort included patients who underwent subtotal cholecystectomy between 2010 and 2020 within a single hospital system. Subtotal cholecystectomy was identified by parsing operative notes for keywords. Demographic and clinical variables were collected by manual review. Patient-reported outcomes were collected via phone using an abbreviated Gastrointestinal Quality-of-Life Index. ResultsWe identified 218 subtotal cholecystectomies, with 113 (51.8%) fenestrating subtotal cholecystectomy and 105 (48.2%) reconstituting subtotal cholecystectomy and a median follow-up of 63 months (interquartile range 27–106). Rates of bile duct injury (0.9% vs 1.0%; P > .99), bile leak (10.6% vs 9.5%; P > .99), and 30-day readmission (7.6% vs 8.0%; P > .99) did not differ between fenestrating and reconstituting subtotal cholecystectomy. For fenestrating subtotal cholecystectomy, the postoperative bile leak rate decreased fourfold when cystic duct closure was achieved (6.0% vs 24.1%; P = .012). Subtotal cholecystectomies completed laparoscopically had fewer postoperative bile leaks (2.9% vs 16.8%; P = .001), fewer wound complications (4.8% vs 13.3%; P = .035), and decreased length of stay (7.00 ± 9.07 vs 10.15 ± 13.50 days; P < .001) compared with open operations. The survey response rate was 38.9% (n = 51/131); 47 patients (92.2%) did not report recurrent biliary pain or postprandial nausea or vomiting, but 19 patients (37.2%) reported dietary restriction. Long-term completion cholecystectomy rate was 0.9%. ConclusionGiven no notable difference in postoperative or quality of life outcomes between subtotal cholecystectomy subtypes, consideration of technique depends on intraoperative conditions. Cystic duct closure during fenestrating subtotal cholecystectomy and laparoscopic completion of subtotal cholecystectomy are associated with improved postoperative outcomes.

Thyroglossal Duct Cyst Carcinoma: Our 12-year Experience in a Tertiary Care Centre.

Malignant transformation in thyroglossal duct cyst is an extremely rare occurrence, papillary carcinoma being the most common type of malignancy. In this study, we present our 12-years experience on this rare pathology. Records of all the patients with thyroglossal duct cyst and thyroid malignancies who were managed between January 2011 and December 2022 were reviewed retrospectively. The data was recorded and studies. Descriptive statistics were used to summarize the data. Out of 112 cases of thyroglossal duct cyst, 11 adult patients had associated carcinoma. Their age ranged from 20 to 68 years with a median age of 32 years. The most common presentation was anterior midline painless neck swelling. The diagnosis was made on final histopathological examination post-operatively. Alignant change is rare complication of the most common congenital thyroid anomaly. This study highlights the occurrence of this disease in adults and provides data on manifestation and management of this rare disease.

Successful Treatment of Nasopalatine Duct Cyst After Maxillary Anterior Implant Surgery: A Case Report.

Sporadic studies have reported the occurrence of nasopalatine duct cysts after maxillary anterior implant surgery, and the treatment methods still have clinical uncertainty. We report a potential therapy method that successfully treated a nasopalatine duct cyst that developed and expanded 1 year after maxillary anterior implant placement following periodontally hopeless teeth extraction. The nasopalatine cyst was treated surgically without removing implants. During flap surgery, the cyst was removed intact, and the exposed implant's surface was debrided thoroughly by hydrogen peroxide (H2O2) rinsing, glycine air polishing, and saline rinsing. To deal with the significant bone defect caused by the cyst, a bovine porous bone mineral injected platelet-rich fibrin (BPBM-i-PRF) complex was applied to fill the defect, following a resorbable collagen membrane to cover. Seven years after surgery, no cyst recurrence was observed, and bone regeneration in the bone graft area was stable. The implants functioned well without mobility. For nasopalatine duct cysts associated with dental implant placement, complete surgical debridement and longitudinal stable bone regeneration are possibly accessible by regenerative surgery without implant removal.

Anatomical parameters do not determine linear breaking strength or dimensions of the porcine biliary system

Abstract Background The porcine gall bladder and cystic duct gained attention in experimental research aimed at improving human clinical care. While the common bile duct has been investigated before, there is almost no data on the porcine cystic duct. Its relevance for research originates from its potential use in xenotransplantation. Methods We included 10 consecutive pigs (1♀, 9♂) that had been sacrificed after participation in another study. At necropsy, the distance from the biliary papilla to the gall bladder (gall bladder distance) was measured. The cystic duct was then subjected to linear traction. Ethical approval for the study was granted. Associations between force measurements and anatomical parameters were tested by correlation analysis. Results The pigs had a mean body weight of 21.9 kg (standard deviation 2 kg), a mean liver weight of 590 g (standard deviation 88 g), and a mean crown rump length of 67.3 cm (standard deviation 3 cm). The gall bladder distance was 8.2 cm (95% confidence interval: 7.6–8.7 cm). The cystic duct withstood mean linear traction forces of 4.8 N (95% confidence interval: 3.7–5.8 N) and could be elongated by a mean of 6 mm (95% confidence interval: 3.9–8 mm). Linear breaking strength was neither correlated to gall bladder distance (R = 0.3, 95% confidence interval: − 0.41 to 0.78, P = 0.406) or crown rump length (R = 0.42, 95% confidence interval: − 0.28 to 0.83, P = 0.222) nor liver weight (R = 0.02, 95% confidence interval: − 0.62 to 0.64, P = 0.954) or body weight (R = 0.36, 95% confidence interval: − 0.35 to 0.81, P = 0.304). This was also true for gall bladder distance. Conclusions Our study indicates that allometric parameters were not associated with the gall bladder distance or its resistance to traction forces. Consequently, substantial variation of these parameters can be expected in these surgically important parameters, which cannot be derived from easily accessible anatomical parameters.

Management of a Todani Type 1b Choledochal Cyst: Case report

This case report describes the management of a Todani Type 1b choledochal cyst in a 26-year-old woman who presented with chronic epigastric dyspepsia and acute epigastric pain. MRI revealed a cystic dilatation of the distal common bile duct. The patient underwent successful surgical excision of the cyst, cystic duct, and gallbladder, followed by reconstruction with a Roux-en-Y hepaticojejunostomy. The postoperative course was uneventful, with discharge on the sixth day. This case highlights the importance of timely diagnosis and surgical intervention to prevent complications such as biliary cirrhosis and malignancy.

Morphological CBCT parameters for an accurate differentiation between nasopalatine duct cyst and the normal nasopalatine canal

BackgroundThe incisive foramen width was a traditional imaging criterion for diagnosing nasopalatine duct (NPD) cysts. Recent CBCT studies demonstrated significant dimensional variations of the nasopalatine canal, which raised questions about the accuracy of this criterion. This study investigated whether nasopalatine canal diameters assessed on CBCT images can accurately differentiate NPD cysts from normal nasopalatine canals.MethodsThe study included 19 patients with NPD cysts (12 (63.2%) males, 7 (36.8%) females, mean age 44.7 ± 13.3), and a control group of 164 patients (72 (43.9%) males, 92 (56.1%) females, mean age 47.25 ± 17.74). CBCT images were retrospectively evaluated. The following nasopalatine canal diameters were measured on reference sagittal, coronal, and axial reformation images: nasal opening anteroposterior (AP) and mediolateral (ML) diameter, oral opening AP (APOO) and ML (MLOO) diameter, nasopalatine canal length, minimum ML (minML) diameter, anterior wall expansion (AWE), nasopalatine canal angle, and the mid-level AP diameter (midAP). All parameters were compared between groups. Discriminant functional analysis (DFA) was applied to detect CBCT parameters that best differentiate the NPD cyst from the normal canal.ResultsPatients with NPD cyst had significantly greater values of APOO (7.06 ± 2.09 vs. 5.61 ± 1.70), MLOO (6.89 ± 2.95 vs. 3.48 ± 1.24), minML (2.88 ± 1.53 vs. 2.25 ± 1.09), AWE (2.15 ± 0.65 vs. 0.41 ± 0.67), and midAP (4.58 ± 1.61 vs. 2.48 ± 0.96). DFA showed MLOO, AWE, and midAP as the most accurate in distinguishing NPD cyst from the normal canal. When combined in the discriminant function equation X = 0.390·MLOO + 1.010·AWE + 0.288·midAP (cut score 1.669), the differentiation can be performed with a sensitivity and specificity of 98.8% and 76.9%, respectively.ConclusionNPD cysts can be accurately distinguished from the normal nasopalatine canal by measuring MLOO, AWE, and midAP diameter on CBCT images.

Benefits of endoscopic gallbladder stenting following percutaneous transhepatic gallbladder drainage.

Endoscopic transpapillary gallbladder drainage is challenging because of the complexity of the procedure and high incidence of adverse events (AEs). To overcome these problems, endoscopic gallbladder stenting (EGBS) after percutaneous transhepatic gallbladder drainage (PTGBD) can be effective, as it mitigates inflammation and adhesion. To examine the benefits of EGBS after PTGBD to assess its efficacy and impact on AEs. We retrospectively analyzed data from 35 patients who underwent EGBS after PTGBD at a single center between January 2016 and December 2023. The primary outcomes were technical success and AEs, and the rate of recurrent cholecystitis was evaluated. In addition, the reasons for the failure of the procedure were identified. Among the 35 patients, the technical success rate was 77.1% and the final contrast of the cystic duct was successful in 97.1% of patients. The incidence of early AEs was relatively low (11.4%), with no instances of cystic duct perforation. The rate of recurrent cholecystitis was 3.7%, and no other biliary events were observed. EGBS after PTGBD may be significantly beneficial, with a substantial success rate and minimal AEs in both short- and long-term follow-ups.

Retrospective comparison of thyroid hormones in Steller sea lions Eumetopias jubatus under professional care with and without thyroid disease.

An evaluation of morbidity and mortality in Steller sea lions (SSLs) Eumetopias jubatus under professional care identified a high prevalence of thyroid disease in aged animals. While studies have investigated the effects of age, season, nutrition, stressors, and pollutants on thyroid hormones in pinnipeds, data from individuals with known thyroid disease are lacking. Histopathological reports of adult SSLs in North American aquariums from 1979 to 2022 with banked serum (n = 14) were reviewed. Radioimmunoassays, which have been validated in this species, were used to determine triiodothyronine (TT3), total thyroxine (TT4), and free thyroxine (fT4). A solid-phase chemiluminescent immunometric assay for thyroid-stimulating hormone (TSH) quantification was validated by testing inter- and intra-assay repeatability, recovery, and parallelism. Lesions included follicular cysts (n = 5), adenoma with thyroglossal duct or follicular cysts (n = 2), medullary or follicular C-cell carcinoma with follicular cysts and nodular hyperplasia (n = 1), neuroendocrine carcinoma with follicular cysts (n = 1), and sarcomatoid carcinoma metastasis to the thyroid (n = 1). Significantly lower concentrations of TT3, TT4, and fT4 in SSLs with thyroid disease (n = 10) versus those without (n = 4) were attributed to space-occupying lesions, advanced age, and/or season. TSH was not significantly different between groups. Fifty percent of diseased SSL profiles were within reference ranges, and all individuals with lesions were clinically euthyroid. These data expand the current understanding of thyroid disease in SSLs and underscore the need for additional diagnostics (e.g. cervical ultrasound) concurrently with hormone assays to effectively screen for underlying abnormalities.

Giant gallbladder cyst with acute cholecystitis: a case report

BackgroundGallbladder cysts are rare diseases with very few reported cases, and no clinical or histological definition has been established. Furthermore, cases of giant cysts outside the gallbladder wall are extremely rare. We report a rare case of giant gallbladder cyst with acute cholecystitis.Case presentationAn 85-year-old woman with appetite loss and right lower abdominal pain lasting 2 days presented to our hospital. At first, the patient’s abdominal pain was mild to moderate with no fever. Blood tests revealed a white blood cell count of 10,950/mm3, and the C-reactive protein (CRP) level was 14.35 mg/dl. A contrast-enhanced computed tomography (CT) scan of the abdomen revealed a grossly distended gallbladder (14.5 × 14.5 × 8.7 cm) with an incarcerated stone in the cystic duct. The patient was treated by percutaneous transhepatic gallbladder drainage (PTGBD) with 735 ml of drainage fluid. Oral contrast magnetic resonance cholangiopancreatography (MRCP) revealed that gallbladder swelling remained (14.0 × 6.5 cm) 3 days after PTGBD. We performed laparoscopic cholecystectomy 6 days after PTGBD. Because of the severe adhesion around the junction of the cystic and common bile ducts, we performed open cholecystectomy.The resected specimen was 14 × 11 cm in size and consisted of a gallbladder (6 × 7 cm) with a stone (2.4 × 1.8 cm) in the gallbladder and a large cystic lesion (18 × 18 cm) outside the gallbladder wall. The cystic lesion had a wall thickness of 6 to 12 mm and internal septal structures and contained hemorrhagic and necrotic tissue.Histological examination revealed that the specimens showed a mildly swollen gallbladder and a cystic lesion on the outside of the gallbladder wall, adjacent to the gallbladder wall, with wall thickening and inflammation. The cystic lesion suggested gallbladder duplication, gallbladder diverticulum or extension of the Rokitansky-Aschoff sinus (RAS). There was no malignancy. The patient’s postoperative course was uneventful, and she was discharged 5 days after the operation.ConclusionWe present a very rare case of giant gallbladder cyst with acute cholecystitis revealed by cholecystectomy.

Indocyanine green in laparoscopic cholecystectomy: utility and correlation with a preoperative risk score

BackgroundThis study aims to compare the visualization of the cystic duct-common bile duct junction with indocyanine green (ICG) among 3 groups of patients divided according to the difficulty of elective laparoscopic cholecystectomy. MethodsConducted at a single center, this non-randomized, prospective, observational study encompassed 168 patients who underwent elective laparoscopic cholecystectomy and were assessed with a preoperative risk score to predict difficult cholecystectomies, including clinical factors and radiological findings. Three groups were identified: low, moderate, and high risk. A dose of 0.25 mg of IV ICG was administered during anesthesia induction and the different objectives were evaluated. ResultsThe visualization of the cystic duct-common bile duct junction was achieved in 28 (100%), 113 (91.1%), and 10 (63%) patients in the low, moderate, and high-risk groups, respectively. The high-risk group had longer total operative time, higher conversion, more complications and longer hospital stay. In the surgeon’s subjective assessment, ICG was considered useful in 36% of the low-risk group, 58% in the moderate-risk group, and 69% in the high-risk group. Additionally, there were no cases where ICG modified the surgeon’s surgical approach in the low-risk group, compared to 11% in the moderate-risk group and 25% in the high-risk group (p < 0.01). ConclusionsThe results of this study confirm that in the case of difficult cholecystectomies, the visualization of the cystic duct-common bile duct junction is achieved in 63% of cases and prompts a modification of the surgical procedure in one out of four patients.

Stage Evaluation of Cystic Duct Cancer

Stage Evaluation of Cystic Duct Cancer

Management of Bile Duct Injury Complicating Cholecystectomy: Experience of the General Surgery Department of Avicenne Military Hospital in Marrakesh

Bile duct injuries are the most feared complication of a commonly performed cholecystectomy, which is generally considered as a safe and benign intervention. Eighteen cases of bile duct injuries were collected through a retrospective study conducted between January 2019 and December 2023 in the general surgery department of the Military Hospital Avicenne in Marrakesh. The average age was 53 years old, sex ratio M/F was 0.38. Acute cholecystitis, acute pancreatitis, obesity and anatomical variations were the main risk factors found in our patients. For 13 patients, the iatrogenic injury had occurred in our department. For the remaining 5 patients, they were referred from peripheral hospitals. Intraoperative diagnosis was made in five cases. In the postoperative period, 6 patients had bile leakage from the drain, 5 patients had abdominal pain, one patient presented incisional bile leakage and one patient had a jaundice. The repair consisted mostly on Roux-en-Y hepaticojejunostomy which was performed in 9 cases. Cystic duct ligation was performed in five cases. Two patients underwent primary repair on common bile duct with T-tube insertion. Two cases were treated by endoscopically. The six months’ follow up was favorable for 66,7% of the cases. The prevention and the respect of surgical rules and recommendations (critical view of safety) during cholecystectomy are the best means to avoid these lesions.

Spectra of well-differentiated neuroendocrine lesions in the extrahepatic biliary system: a case series.

Neuroendocrine tumours (NETs) occurring in the extrahepatic biliary system are exceedingly rare. While NETs typically manifest as mass lesions, the occurrence of microscopic neuroendocrine cell proliferation without a distinct mass remains undocumented at this location. This study aims to characterise the clinicopathological features of a series of well-differentiated neuroendocrine lesions involving the extrahepatic biliary tree, including mass forming NETs and microscopic non-mass-forming neuroendocrine cell proliferation, designated neuroendocrine cell micronests (NCMs). Surgical resections of NETs/NCMs involving the extrahepatic bile ducts and gallbladder were identified from electronic pathology databases among seven institutions spanning from January 2011 to September 2023. Clinical and histological findings were recorded. Ten patients (four female, six male: age range = 34-75 years) were included in the study. Histopathological examination revealed visible mass-forming lesions in four cases (1.6-14.0 cm in size), identified in the gallbladder (n = two) or extrahepatic bile duct (n = two), all diagnosed as well-differentiated NETs. The remaining six cases revealed incidental non-mass-forming NCMs in either the cystic duct (n = two), common bile duct (n = three) or gallbladder (n = one), ranging from < 0.1 to 0.4 cm; four were associated with biliary lithiasis. No evidence of metastasis or recurrence was seen in the follow-up period (range = 0.1-11.2 years). This study highlights the spectrum of extrahepatic biliary well-differentiated neuroendocrine lesions, ranging from incidental microscopic NCMs to grossly apparent mass-forming NETs, potentially requiring different clinical management. Noteworthy is the frequent association of incidental microscopic neuroendocrine cell proliferations with biliary lithiasis, indicating a potential neuroendocrine metaplastic pathogenesis that merits further exploration.

Reconstruction of Pathology Induced Anterior Maxillary Defect: A Case Report

A cyst is defined as a pathologic cavity lined by epithelium. Nasopalatine duct cysts (NPDC) are of non-odontogenic origin arising from epithelial remnants from two embryonic nasopalatine ducts. These cysts may form anywhere along the ducts’ course, which runs from posterior palatal midline to the soft tissue palatine papilla also known as the incisive papilla. NPDC often develop between the 4th and 5th decades of life with men being affected more than women (2:1 ratio). They are typically asymptomatic but present with palatal swelling in the anterior maxillary region. Larger cysts may create a labial expansion in addition to a midpalate expansion which is usually compressible due to resorption of bone beneath the mucosa. Radiography often shows a well demarcated round or pear-shaped radiolucency superimposed on the incisive canal, tooth displacement or divergence of roots may be observed. This pathology is usually greater than 6mm in size which differentiates it from the incisive canal. Differential diagnoses often include a periapical granuloma or radicular cyst from nonvital central incisors, however a palatal radiolucency and expansion represents a NPDC until proven otherwise. Typical treatment includes enucleation and curettage with low recurrence rates.

WP3.3 - Surgical Management of multiple mega large stones of a congenitally low inserted Cystic Duct – A Case Report

Abstract Introduction Low cystic duct insertion is uncommon, and the presence of multiple large stones in the cystic duct with normal laboratory investigation is rare. The infrequency with which it is encountered and the management done makes this an interesting presentation. Case presentation A 61-year-old female with incidental gall stones and possible CBD/cystic duct stones on a CTAP during a workup for management of an incisional hernia of the abdomen. The patient initially presented with abdominal pain that was thought to be due to the incisional hernia. On examination, the patient had a soft abdomen with no jaundice and normal laboratory investigations. MRCP scan demonstrated multiple gall stones and cystic duct stones suggestive of Mirizzi syndrome. The patient underwent laparoscopic repair of the incisional hernia and cholecystectomy with an on-table cholangiogram. Cholangiogram showed a low inserting cystic duct joining the common hepatic duct at the sphincter of Oddi with an almost nonexistent common bile duct and a cystic duct containing multiple mega-large stones. The cystic duct was explored and stones were milked out except the most inferior stone which was impacted at the sphincter of Oddi. This was dislodged with a Fogarty catheter and all stones were retrieved. Completion cholangiogram demonstrated complete clearance of the biliary tree with dye entering the duodenum. The patient recovered well postoperatively with no complications at 1 month post-operative. Conclusion This case illustrates a rare presentation of large cystic duct stones in the presence of abnormal anatomy and provides an option for surgical management.

EP23 - A rare case of “Gastric Outlet Obstruction (GOO) Secondary to Hydrops of Gallbladder” caused by recurrent acalculous cholecystitis: a variant of Bouveret’s Syndrome -a rare case and review of literature

Abstract We present an extremely rare case of gastric outlet obstruction (GOO) in a young male attributed to hydrops of the gallbladder resulting from recurrent episodes of acute acalculous cholecystitis. Remarkably, approximately one and half years prior to this presentation, the patient was diagnosed with confirmed acute acalculous cholecystitis and had tested positive for Covid 19, despite exhibiting no respiratory symptoms. While it is established that Patients with acute acalculous cholecystitis can develop gallbladder mucoceles due to the mechanism akin to mechanical cystic duct obstructions. This functional condition leads to a non-emptying, distended gallbladder where biliary mucus replaces bile salts (1). Conventionally, hydrops of the gallbladder is associated with prolonged blockage of the cystic duct, often caused by an impacted gallstone in neck / cystic duct or a stricture in cystic duct. Bouveret’s Syndrome, characterized by GOO results from the impaction of a large gallstone in the duodenum or pyloric channel, typically secondary to a cholecystoenteric fistula (2),is a recognized rare entity. However, our case stands apart as it elucidates an infrequently reported cause of GOO- hydrops of gall bladder inducing extrinsic compression of the duodenum / pylorus and this case also emphasizes the distinction from Bouveret’s syndrome. This case underscores the importance of considering unusual etiologies in the diagnosis of GOO and emphasizes the need for timely recognition and intervention in such rare instances to ensure optimal patient outcomes. Additionally, we provide a comprehensive review of existing literature, highlighting the scarcity of reported cases with such relevant presentations.

ThP3.14 - Four-Year Experience of Laparoscopic Transcystic common bile duct exploration at a District Hospital

Abstract Aim This study aims to assess the outcomes of Laparoscopic Common Bile Duct Exploration (LCBDE) as a single-stage procedure for symptomatic choledocholithiasis. Methods In this retrospective analysis we included 87 patients with high suspicion of common bile duct (CBD) stones, imaging proven choledocholithiasis or failed Endoscopic Retrograde cholangiopancreatography (ERCP). These patients underwent either LCBDE or CBD exploration under fluoroscopy between 2019 and 2023. Results Among the 87 patients selected for a single stage procedure, 59 underwent Laparoscopic transcystic CBDE. Successful CBDE was achieved in 40 cases (68%), with four patients after failed ERCP. In one case on table ERCP with rendez-vous technique was used to complete CBD clearance. Two of them needed complementary post operative ERCP to remove impacted stones. Most cases with unsuccessful CBDE, 19 in total (32%), was due to difficult cannulation of a narrow cystic duct. Three were managed with on table ERCP and five had post-operative ERCP. Six patients (7%) experienced unplanned readmissions, three with retained stones post-successful stone clearance and two after clear on table cholangiogram, who were managed with ERCP. Bile leak occurred in two cases and it was self-limited within 14 days. The mean hospital length of stay (LOS) was 5,3 days with a median LOS of 4 days. Conclusion Transcystic LCBDE, when surgical expertise and experience are available, is an effective and safe procedure for treating choledocholithiasis, providing comprehensive CBD clearance while avoiding the risks associated with ERCP.