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Abstract

AbstractTitle: Variability in Practice and Outcomes of Laparoscopic Cholecystectomy and Bile Duct Exploration (LCBDE) for Treatment of Bile Duct Stones– a Survey and Multi-Centre Audits of Practice in the UKIntroduction: The practice of managing suspected/confirmed bile duct stones (BDS) can vary significantly in the UK. The optimal management approach for suspected or confirmed BDS in patients with symptomatic gallstones remains unclear. We aimed to assess this variability in practice and outcomes of laparoscopic bile duct exploration in the UK.Methods: A UK-wide survey and two national multicentre audits were conducted. An electronic survey containing 40 questions on various aspects of management of BDS was sent to surgeons who perform cholecystectomies via five surgical associations. The Retrospective Study (R-ALiCE) involved 18 centres across the UK and collected data between January 1, 2015, and December 31, 2019. The prospective study P-ALiCE collected data prospectively between January 1, 2021, and August 31, 2021.Results: Survey: A total of 132 surgeons responded. For suspected CBD stones, 80% preferred magnetic resonance cholangiopancreatography. Most preferred intra-operative cholangiogram over intraoperative ultrasound (83% vs 17%). For treatment, 62.1% preferred a two-stage approach, involving endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). In comparison, 33.4% chose a single-stage approach, LC with intraoperative imaging and bile duct exploration (LCBDE). "Availability of excellent ERCP service" and "lack of formal training" were the main barriers to performing LCBDE.R-ALiCE: 1,689 patients were included (68.2% female, median age 59 years). Trans-cystic BDE (TC-LBDE) was attempted in 71.5% with a 77.6% success rate. The trans-choledochal approach (TD-LBDE) was attempted in 41% of cases, with a failure rate of 6.6%. Bile leak rate was significantly higher in TD-LBDE (8.8%) versus TC-LBDE (1.4%) (OR=6.76; 95% confidence intervals:3.75- 12.19; P<0.001). The retained stone rate was 4.4%. Overall morbidity was 18.9%. Clavien-Dindo grade III or higher complications occurred in 8.8% of patients. 30-day mortality was 0.4%.P-ALiCE: 314 LCBDE from 23 centres demonstrated 88.7% overall clearance (85.2% TC-LBDE, 94.5% TD-LBDE). The bile leak rate was 2%, retained stones occurred in 4% of cases, and pancreatitis was reported in 1% of cases. The overall complication rate was 12%, with over 70% being Grade I-II.Conclusions: LCBDE is a safe and effective approach for managing BDS, with low rates of severe complications, including bile leak, post-operative pancreatitis, and retained stones. The trans-cystic approach is associated with a lower bile leak rate than the trans-ductal approach.

Awarding Institution(s)

University of Plymouth

Supervisor

Somaiah Aroori, Matthew Cramp, Ashwin Dhanda, Adam Streeter

Document Type

Thesis

Publication Date

2026

Embargo Period

2026-09-01

Deposit Date

September 2026

Creative Commons License

Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License

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