Safety and outcomes of laparoscopic bile duct exploration: a UK-wide multi-centre study (R-ALiCE)

The optimal management approach for suspected or confirmed bile duct stones (BDS) in patients with symptomatic gallstones remains unclear. This study evaluates outcomes and safety profile of laparoscopic common bile duct exploration and cholecystectomy (LCBDE) from a UK-wide multi-centre study.

The "Retrospective Audit of Laparoscopic Common Bile Duct Exploration (R-ALiCE)", study involved 18 centres across the UK. Adult patients undergoing LCBDE for BDS between 01/01/2015 and 31/12/2019 were included. Patients who underwent LCBDE for non-stone disease and as part of another operation were excluded from the study.

1,689 patients (68.2% female, median age: 59 years) were included. The open conversion rate was 5% (n = 84). Trans-cystic LCBDE (TC-LCBDE) was attempted in 71.5% (n = 1207) (success rate, 77.6%, n = 937). Trans-choledochal-LCBDE (TD-LCBDE) was performed in 41% (694), with 28.5% being direct-to-trans-ductal explorations. The TD-LCBDE success rate was 93.4% (n = 648). The bile leak rate was 4.4% (n = 75) (61, 8.8% in TD-LCBDE vs. 14,1.5% in the TC-LCBDE, Odds Ratio = 6.76; 95% CI 3.75-12.19; P < 0.001). The retained stone rate was 4.4% (n = 74) (4.1% in TC-LCBDE vs. 4.8% in TD-LCBDE; P = 0.53). Postoperative pancreatitis occurred in 0.9% (n = 15) (0.8% for TC-LCBDE vs. 1% for TD-LCBDE; P = 0.65). The bile duct stricture rate was 0 at 90-day follow-up. The 30-day readmission rate was 7.5% (n = 127). The median length of stay was 3 days (range 2-7). Overall morbidity and Clavien-Dindo grade ≥ III complications rate were 18.7% (n = 316) and 8.8% (n = 149), respectively. The 30-day mortality rate was 0.4% (n = 7).

LCBDE is a safe and effective approach for managing BDS, with low rates of severe complications, including bile leak, postoperative pancreatitis, and retained stones. The trans-cystic approach is associated with a lower bile leak rate than the trans-ductal approach.