TTP6.02 Transcystic Bile Duct Exploration with a Disposable Choledochoscope: A Single-Center Retrospective Case Series

Aims Laparoscopic transcystic common bile duct exploration (LTCBDE) enables single-stage treatment of choledocholithiasis and cholelithiasis, avoiding the risks of a two-stage approach with ERCP. This study evaluated the safety and effectiveness of our initial experience using disposable choledochoscope. Methods This was a single-centre prospective case series between June 2023 to December 2024, operations carried out by two biliary surgeons. All consecutive patients undergoing laparoscopic cholecystectomy, intra-operatice cholangiogram (IOC) and LTBED were included. Boston Scientific SpyGlassTM Discover was used to carry out LTCBDE. Results 53 patients underwent LTCBDE, the median age was 47 years (IQR 36-60) and 39 (73.4%) were female. 43 (81.1%) were emergency or semi-urgent cases. Pre-operatively, 16 (30.2%) were not known to have bile duct stones. 52 (98.1%) were completed transcystically and one was converted to formal choledochotomy. 52 (98.1%) patients had complete clearance of bile duct, one requiring intra-operative ERCP. There were no conversion to open surgery and 12 (22.6%) required sub-hepatic drain. Median post-operative hospital stay was 1 day (IQR 1-2). Two (3.8%) patients were re-admitted to hospital within 30 days of surgery, and 2 (3.8%) required a ERCP within 6 months of surgery, one for clearance of bile duct and one for cholangitis (no stones). One (1.9%) patient had Clavien-Dindo grade ≥ 3 complication (requiring ERCP). Conclusion Our study demonstrates that LTCBDE is a safe and effective treatment option in elective as well as emergency setting, eliminating the risks associated with ERCP.