SRS204 - Setting up a single-stage laparoscopic bile duct exploration service at a Central London Trust: first year experience

Abstract Aims Traditionally, patients with Common Bile Duct (CBD) stones at our trust underwent ERCP followed by interval cholecystectomy. However, ERCP is only available at one site, leading to treatment delays and long surgical waiting lists. To address this, a single-stage pathway was established, combining laparoscopic cholecystectomy and bile duct exploration (LC + LCBDE), performed by a single surgeon across three Central London hospitals. This model aims to streamline care and reduce delays. Methods Between June 2024 and June 2025, patients from three hospital sites were referred for LC + LCBDE via emergency or expedited elective pathways. This study outlines tools developed to standardise the CBD-stone pathway: consultant-led briefings; reproducible patient positioning (‘French, Lloyd-Davis’); a standardised LCBDE trolley for efficient equipment access; and an intraoperative approach following the Leveraging Access to Technology and Enhanced Surgical Technique (LATEST) protocol, using ultrathin 3mm choledochoscopes, Lithotripsy-Assisted Bile duct Exploration by Laparoendoscopy (LABEL), and cysticocholedochal angle correction via abdominal-wall retraction. Results A total of 49 patients (31 female, 18 male; mean age 57) underwent LC + LCBDE. Presentations included pancreatitis (16), biliary colic/cholecystitis (19), cholangitis (6), obstructive jaundice (3), and deranged LFTs (5). Stone clearance was 98% successful, with a 6% morbidity rate. Median operative-time was 117 min. 51% were discharged the same day. Fourteen cases were emergencies; 10 had no stones found. Six patients had altered anatomy (Roux-en-Y). Estimated annual savings: £50 000–£100 000. Conclusions A single-stage CBD stone service is safe, feasible, and effective, offering reduced delays, lower costs, few complications, and decreased reliance on ERCP.