Impact of single‐stage laparoscopic trans‐cystic exploration on hospital procedures, admissions and length‐of‐stay in common bile duct stone clearance

Abstract

Background Single‐stage approach with bile duct exploration is considered the most efficient and cost‐effective method of bile duct clearance. In Australia, apart from centres with subspecialty interests, notably in Brisbane, Queensland, a multi‐stage approach with endoscopic retrograde cholangiopancreatography (ERCP) is used more frequently. We aim to evaluate the impact of single stage laparoscopic trans‐cystic exploration (LTCE) versus multi‐stage approach for choledocholithiasis. Methods This was a retrospective cohort study. Medicare Benefits Schedule codings were used to identify patients who had the following procedures between December 2011 and December 2019: laparoscopic cholecystectomy (LC) and ERCP, LC and LTCE, LC and LTCE and ERCP. Primary outcomes were number of hospital procedures, admissions and additive length of stay (aLOS), the cumulative hospital stay from admission to discharge. Results Of 607 patients, 204 (34%) patients received a single‐stage LTCE, while 403 (66%) patients had a multi‐stage approach. In the LTCE group, 82% (168) patients and 93% (190) patients had one procedure and one admission respectively for stone clearance (P = 0.001). The median aLOS was 4 days for LTCE versus 7 days for multi‐stage approach (P = 0.001; 95% CI for difference − 3 to −2). In the multi‐stage group, 16% (65) patients had three or more procedures and 49% (199) patients required two or more hospital admissions to achieve stone clearance. Conclusion LTCE for stone clearance can be successfully accomplished with reductions in hospital admissions, number of procedures and length of stay. This has further economic and health resource implications.

Analysis of Efficacy and Safety of Laparoscopy Plus Choledochoscopy Combined With Holmium Laser Lithotripsy for Choledocholithiasis and Hepatolithiasis

“…The shift to minimally invasive techniques such as laparoscopy combined with choledochoscopy and holmium laser lithotripsy has reduced trauma, complications, and promoted faster recovery [ 16 , 17 ]. Holmium laser lithotripsy enhances stone removal and success rates [ 18 , 19 ]. It reduces blood loss and improves recovery, making the surgery less physically and psychologically impactful [ 20 ].…”