Ann Hepatobiliary Pancreat Surg.  2022 Nov;26(4):333-338. 10.14701/ahbps.22-001.

The single-stage management of bile duct stones is underutilised: A prospective multicentre cohort study with a literature review

• Tanase A
• Russell TB
• Platt T
• Griffiths EA
• Aroori S
• On behalf of the CholeS study group
• West Midlands Research Collaborative (please see Supplementary Data for details)

• KMID: 2536383
• DOI: http://doi.org/10.14701/ahbps.22-001

Abstract

Backgrounds/Aims
Bile duct stones (BDS) can be managed either prior to laparoscopic cholecystectomy (LC) using endoscopic retrograde cholangiopancreatography (ERCP) or with laparoscopic bile duct exploration (LBDE) at the time of LC. The latter is underutilised. The aim of this study was to use the dataset of the previously performed CholeS study to investigate LBDE hospital volumes, LBDE-to-LC rates, and LBDE outcomes.
Methods
Data from 166 United Kingdom/Republic of Ireland hospitals were used to study the utilisation of LBDE in LC patients.
Results
Of 8,820 LCs performed, 932 patients (10.6%) underwent preoperative ERCP and 256 patients (2.9%) underwent LBDE. Of the 256 patients who underwent LBDE, 73 patients (28.5%) had undergone prior ERCP and 112 patients (43.8%) had undergone prior magnetic resonance cholangiopancreatography. Fifteen (9.0%) of the 166 included hospitals performed less than five LBDEs in the two-month study period. LBDEs were mainly performed by upper gastrointestinal surgeons (84.4%) and colorectal surgeons (10.0%). Eighty-seven percent of the LBDEs were performed by consultants and 13.0% were performed by trainees. The laparoscopic-to-open conversion rate was 12.5%. The median operation time was 111 minutes (range: 75–155 minutes). Median hospital stay was 6 days (range: 4–11 days) for emergency LBDEs and 1 day (range: 1–4 days) for elective LBDEs. Overall morbidity was 21.5%. Bile leak rate was 5.3%. Thirty-day readmission and mortality rates were 12.1% and 0.4%, respectively.
Conclusions
The single-stage approach to managing BDS was underutilised. An additional prospective study with a longer study period is needed to verify this finding.

Keyword

Bile duct; Endoscopic retrograde cholangiopancreatography; Choledocholithiasis; Gallstones; Laparoscopic cholecystectomy

Figure

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  Fig. 1 Graph illustrating the number of laparoscopic bile duct explorations (LBDEs) performed by the included hospitals during the two-month study period. a)Outlier: one hospital performed 65 LBDEs.

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