MTP5.05 Cholangioscopy-assisted electrohydraulic lithotripsy as a treatment for large bile duct stones: a single centre experience

Aim Laparoscopic transcystic common bile duct exploration (LTCBDE) provides a safe and definitive treatment for choledocholithiasis. Electrohydraulic lithotripsy (EHL) enables the management of large bile duct and/or impacted stones, avoiding the need for formal choledochotomy or endoscopic retrograde cholangiopancreatography (ERCP) with associated complications. This study aimed to describe our experience with EHL in LTCBDE. Methods This single-center prospective case series, conducted from June 2023 to December 2024, included all consecutive patients undergoing cholangioscopy-assisted lithotripsy performed by two biliary surgeons. The Boston Scientific SpyGlass™ Discover system and electrohydraulic lithotripsy (EHL) were used for bile duct clearance. Results 53 patients underwent LTCBDE and of these 16 patients (30.2%) required EHL to clear the bile duct. 11 (68.8%) were female, with a median age of 43 years. 15 (93.8%) patients had bile duct cleared trans-cysticaly and one (6.3%) required conversation to formal choledochotomy with particle clearance of the bile duct due to large stone burden. The median length of stay post-operatively was 1 day (IQR 1-2). One (6.3%) patient was readmitted within 30 day due to cholangitis requiring ERCP (no stones) and another patient had ERCP post op due to partial clearance of the bile duct. Conclusion Our findings demonstrate that a single-stage transcystic approach with EHL is a safe and effective treatment for managing large bile duct and/or impacted stones. This avoid the morbidity associated with choledochotomy and ERCP.