The optimal management approach for suspected or confirmed bile duct stones (BDS) in patients with symptomatic gallstones remains unclear. This study evaluates outcomes and safety profile of laparoscopic common bile duct exploration and cholecystectomy (LCBDE) from a UK-wide multi-centre study.
The "Retrospective Audit of Laparoscopic Common Bile Duct Exploration (R-ALiCE)", study involved 18 centres across the UK. Adult patients undergoing LCBDE for BDS between 01/01/2015 and 31/12/2019 were included. Patients who underwent LCBDE for non-stone disease and as part of another operation were excluded from the study.
1,689 patients (68.2% female, median age: 59 years) were included. The open conversion rate was 5% (n = 84). Trans-cystic LCBDE (TC-LCBDE) was attempted in 71.5% (n = 1207) (success rate, 77.6%, n = 937). Trans-choledochal-LCBDE (TD-LCBDE) was performed in 41% (694), with 28.5% being direct-to-trans-ductal explorations. The TD-LCBDE success rate was 93.4% (n = 648). The bile leak rate was 4.4% (n = 75) (61, 8.8% in TD-LCBDE vs. 14,1.5% in the TC-LCBDE, Odds Ratio = 6.76; 95% CI 3.75-12.19; P < 0.001). The retained stone rate was 4.4% (n = 74) (4.1% in TC-LCBDE vs. 4.8% in TD-LCBDE; P = 0.53). Postoperative pancreatitis occurred in 0.9% (n = 15) (0.8% for TC-LCBDE vs. 1% for TD-LCBDE; P = 0.65). The bile duct stricture rate was 0 at 90-day follow-up. The 30-day readmission rate was 7.5% (n = 127). The median length of stay was 3 days (range 2-7). Overall morbidity and Clavien-Dindo grade ≥ III complications rate were 18.7% (n = 316) and 8.8% (n = 149), respectively. The 30-day mortality rate was 0.4% (n = 7).
LCBDE is a safe and effective approach for managing BDS, with low rates of severe complications, including bile leak, postoperative pancreatitis, and retained stones. The trans-cystic approach is associated with a lower bile leak rate than the trans-ductal approach.
Surgical endoscopy. 2026 Jan 13 [Epub ahead of print]
Somaiah Aroori, Tanase Andrei, Ahmad Nassar, Tarek Z Katbeth, Scott MacDonald, Rhona Kilpatrick, Andrew Healey, Artur Zanellato, Saskia Clark-Stewart, Simon Paterson-Brown, Vivienne Gough, Chee Siong Wong, Laura McMurray, Alberto Martinez-Isla, Lalin Navaratne, Fatima Senra, Matyas Fehervari, Richard Morgan, Sreedutt Murali, Mostafa Abdelkarim, Gowtham S Venkatesan, Ian Finlay, Mahmoud Al-Ardah, Hannah Rottenburg, Ashraf Rasheed, Harriet Whewell, Tamsin Boyce, Stuart Mercer, Iain Wilson, Samantha Body, Imran Bhatti, Altaf Awan, Javed Latif, Nienke Warnaar, Sreelakshmi Suresh, Anahita Shahmiri, Cazz Croxon, Andrew G N Robertson, Peter J Driscoll, Danielle Gabriele ClydeMarangoni, Jawad Ahmad, Suzanne Fitzpatrick, Michael Silva, Syed Hussain Abbas, Carlo Ceresa, Moustafa Mourad, Ahmed Elmaradny, Katerina Thomas-Fernandez, Jed Maliyil, Michael Pellen, Alex Wilkins, Shahani Nazir, Heather Spence, Ewen A Griffiths, Oluwasina Dada, Keval Dabhi, Mohammed Hoque, Giuseppe Garcea, Tareq Al Saoudi, Suchita Bahri, Samir Roked, Streeter Adam, Dorothy Kuek, Sera Sarsam, Pooja Dhavala, Cramp Matthew, Danda Ashwin, R-ALiCE Collaborators
Consultant HPB and Transplant Surgeon, University Hospitals Plymouth NHS Trust, Peninsula Medical School, University of Plymouth England, Plymouth, England, UK. ., Consultant HPB and Transplant Surgeon, University Hospitals Plymouth NHS Trust, Peninsula Medical School, University of Plymouth England, Plymouth, England, UK., University Hospital Monklands, NHS Lanarkshire, Airdrie, ML6 0JS, UK., Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, Scotland, UK., Royal Alexandra Hospital, Paisley - NHS Greater Glasgow and Clyde, Paisley, PA2 9PN, Scotland, UK., London North West University Healthcare NHS Trust, Harrow, HA1 3UJ, UK., Glan Clwyd Hospital - Betsi Cadwaladr University Health Board, Bodelwyddan, Rhyl, LL18 5UJ, UK., Royal Cornwall Hospital, Treliske, Truro, UK., Royal Gwent Hospital - Aneurin Bevan University Health Board, Caerleon, Wales, UK., Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, PO6 3LY, UK., University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK., East Suffolk and North Essex NHS Foundation Trust, Colchester, UK., Victoria Hospital, NHS Fife, Kirkcaldy, Scotland, UK., University Hospitals Coventry & Warwickshire, Coventry, CV2 2DX, UK., Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Worcestershire Acute Hospitals NHS Trust, Worcester, England, UK., Hull University Teaching Hospitals NHS Trust, Hull, HU3 2JZ, England, UK., University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., University Hospitals of Leicester NHS Trust, Leicester, England, UK., University of Plymouth, Plymouth, England, UK.