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Background <p>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.</p> Methods <p>The&#xa0;“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&#xa0;part of another operation were excluded from the study.</p> Results <p>1,689 patients (68.2% female, median age: 59&#xa0;years) were included. The open conversion rate was 5% (<i>n</i> = 84). Trans-cystic LCBDE (TC-LCBDE) was attempted in 71.5% (<i>n</i> = 1207) (success rate, 77.6%, <i>n</i> = 937). Trans-choledochal-LCBDE&#xa0;(TD-LCBDE) was performed in 41% (694), with 28.5% being direct-to-trans-ductal explorations. The TD-LCBDE success rate was 93.4% (<i>n</i> = 648). The&#xa0;bile leak rate was 4.4% (<i>n</i> = 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; <i>P</i> &lt; 0.001). The retained stone rate was 4.4% (<i>n</i> = 74) (4.1% in TC-LCBDE vs. 4.8% in TD-LCBDE; <i>P</i> = 0.53). Postoperative pancreatitis occurred in 0.9% (<i>n</i> = 15) (0.8% for TC-LCBDE vs. 1% for TD-LCBDE; <i>P</i> = 0.65). The bile duct stricture rate was 0 at 90-day&#xa0;follow-up. The 30-day readmission rate was 7.5% (<i>n</i> = 127). The median length of stay was 3&#xa0;days (range 2–7). Overall morbidity and Clavien–Dindo grade ≥ III complications rate were&#xa0;18.7% (<i>n</i> = 316) and 8.8% (<i>n</i> = 149), respectively. The 30-day mortality rate was 0.4% (<i>n</i> = 7).</p> Conclusion <p>LCBDE&#xa0;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.</p>

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Safety and outcomes of laparoscopic bile duct exploration: a UK-wide multi-centre study (R-ALiCE)

  • 期刊论文

  • 发表日期：

    2026年1月13日

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  • 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 Clyde,
  • Gabriele Marangoni,
  • 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

摘要

Background

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.

Methods

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.

Results

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).

Conclusion

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.