Patient Selection and Barriers to Day-Case Laparoscopic Common Bile Duct Exploration: A Retrospective Cohort Study

Same-day discharge following laparoscopic common bile duct exploration (LCBDE) remains uncommon despite increasing use of single-stage management for choledocholithiasis. This study evaluated the safety and feasibility of day-case LCBDE, factors associated with postoperative length of stay, and potentially modifiable barriers to same-day discharge.

Data were collected retrospectively from 851 consecutive patients who underwent LCBDE for choledocholithiasis between September 2008 and December 2022. Patients were grouped by postoperative length of stay (POD0, POD1 or POD ≥ 2), with clinical and operative characteristics compared between groups. Safety outcomes and documented reasons for overnight admission amongst patients discharged on POD1 were examined.

Sixteen patients (1.9%) were discharged on POD0, 305 (35.8%) on POD1 and 530 (62.3%) on POD ≥ 2. POD0 patients were younger, more often elective, had lower inflammatory and obstructive markers, and underwent shorter procedures. No POD0 patient developed a postoperative complication, had a retained common bile duct stone or was readmitted within 90 days. Amongst POD1 patients with successful transcystic LCBDE, drain monitoring accounted for 55.5% of documented overnight admissions and postoperative blood testing for 16.3%. No patient in this POD1 subgroup developed a recorded bile leak, postoperative haemorrhage or required reoperation.

Same-day discharge following uncomplicated transcystic LCBDE appears feasible in selected patients. Successful uncomplicated transcystic exploration, together with patient factors may help guide selection for same-day discharge, while more selective use of abdominal drain and postoperative blood testing may reduce unnecessary overnight admission.