SP7.09 Transvesical Bile Duct Exploration: A Viable Option When Cystic Duct Access is Unavailable

Aim Laparoscopic transcystic bile duct exploration (LTCBDE) offers a single-stage treatment for choledocholithiasis, avoiding the risks associated with ERCP and choledochotomy. However, in cases with a difficult hepatocystic triangle, accessing the cystic duct via Hartmann’s pouch may provide a viable alternative. This study aims to describe our experience with laparoscopic transvesical bile duct exploration (LTVBDE) in these challenging cases. Methods This single-centre prospective case series, conducted between June 2023 and December 2024, included operations performed by two biliary surgeons. All patients undergoing laparoscopic cholecystectomy, intra-operative cholangiogram, and bile duct exploration during this period were analyzed. Boston Scientific SpyGlass™ Discover was used to perform the procedure. Results Nine patients underwent LTVBDE, with a median age of 44.8 years (IQR 33-60), and 7 were female. Seven of the cases were emergencies. Pre-operatively, 8 patients were diagnosed with acute cholecystitis, and 7 had known bile duct stones. Indications for LTVBDE included inability to achieve the Strasberg critical view of safety, stone impaction at the junction of Hartmann’s pouch and the cystic duct, or a very short cystic duct. All patients had complete bile duct clearance, with one requiring intra-operative ERCP. There were no conversions to open surgery, and no patients were readmitted within 30 days. The median postoperative hospital stay was 2 days (IQR 1-2). Conclusion Our study demonstrates that LTVBDE is a safe and effective treatment for patients with bile duct stones, particularly when accessing the cystic duct through conventional methods is unsafe or unfeasible.