eP417 Trans-cystic vs Trans-choledochal Approaches: Insights from District General Hospital in Northern Ireland

Aim This study evaluates the Key Performance indicators (KPIs) of Bile Duct Exploration (BDE) such as bile duct clearance, conversion rate, bile leak, return to theatre and overall post-operative mortality in a District General Hospital in Northern Ireland. Methods 81 BDE patients from January 2019 to July 2024 were identified, and 55 of them were analysed. Data including age, gender, type of surgery, preoperative liver function tests and common bile duct (CBD) diameter, were collected. Operative data was categorised into Group-A (trans-cystic) and Group-B (trans-choledochal) and these two groups were compared for the KPIs. Results The mean age was 51.5±18.8 years, with a mean operative time of 3:08±1:08 hours. Normal bilirubin levels were found in 54.5% (n=30) of patients. 9.1% (n=5) had open BDE. Group-A accounted for 43.6% (n=24) of procedures and Group-B 54.5% (n=30), with one trans-cystic case converted to trans-choledochal. T-tubes were placed in 3 Group-B patients. No complications were noted in Group A as compared to 30% (n=9) in Group-B. Bile leaks occurred in 2 Group-B patients, both required return to theatre for washout, one required ERCP with a stent. 5 patients had post-operative ERCP for retained stones within 1 year of BDE. The clearance rate was 100% (n=24) in Group-A and 83.3% (n=25) in Group-B. Conclusions Our data suggested bilirubin as an unreliable predictor for bile duct stones; a triple assessment combining clinical presentation, liver function tests, and radiological evidence offers better diagnostic accuracy.