TTP5.04 Biodegradable biliary stent to prevent bile leaks post-choledochotomy: a mini case-series of four patients who received ARCHIMEDESTM* BPS

Aims Bile leak is a recognised risk of choledochotomy, with associated significant morbidity. Biliary stenting may reduce bile leak risk; however, traditional plastic stents require endoscopic removal and have an incidence of pancreatitis, which discourages use. ARCHIMEDESTM* is a biodegradable biliary and pancreatic stent, offering preferential biliary drainage by the ampulla of Vater. It has been demonstrated to reduce post-operative complications, including bile leaks, following liver transplants. We evaluate use of biodegradable biliary stents in choledochotomy for bile duct exploration versus primary closure. Primary outcome is bile leak rate, secondary outcomes include length of stay, operative time and post-operative complications. Method This retrospective analysis presents a four-patient series of laparoscopic cholecystectomy and bile duct exploration between October 2023 and July 2024. Comparison data covers a two-year period. Results The first patient had a self-limiting bile leak after incorrect stent placement. There were no complications in the subsequent patients, giving an overall bile leak rate of 25%. Whereas there was a 12.5% leak rate in the primary closure group. There were no instances of pancreatitis in either group. Length of stay was similar across both groups; stent (2.7 days) compared to primary closure (2.3 days). Stent placement increased mean operative time; stent (231 minutes) compared to primary closure (190 minutes). Conclusion Preliminary results suggest that ARCHIMEDESTM*stent placement following choledochotomy is safe and may reduce post-operative complications, including bile leaks when placed correctly. A learning curve is required to ensure adequate stent placement.