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Recommended Performance Standards for Laparoscopic Bile Duct Exploration

LCBDE as a procedure is within the remit of all UK consultant Upper GI surgeons with adequate training and experience

As LCBDE training/competence is not currently defined, new unit providers of LCBDE should have attended an accreditation course and receive external mentorship in their initial experience as part of good medical practice.

Annual audit of outcomes

If a LCBDE service is available within your hospital, patients should be made aware that laparoscopic bile duct exploration with cholecystectomy is an alternative treatment to 2 stage treatment laparoscopic cholecystectomy + ERCP

Those patients who have had previous cholecystectomy should have ERCP as the primary treatment option for new presentation of CBD stones

CBD stones refractory to extraction by ERCP/Spyglass - If LCBDE is not available locally, arrangements should be made for referral of suitable surgical patients to a nearby unit that does, rather than treatment with repeated biliary stents

Trans-Cystic exploration should be considered as the primary approach (less morbidity) if size of stones and anatomy allow

Natural history of small CBD stones is unclear- acceptable to treat if clinical indication, presence of deranged liver function tests/pancreatitis/cholangitis

Bile Duct diameter for choledochotomy should be ≥10mm to limit risk of bile duct stenosis, ≥8mm in a high volume/experienced LCBDE surgeon’s hands

Choledochotomy should be performed vertically using sharp dissection (not diathermy)

Bile ducts should be closed primarily and a T tube applied only for a specific indication (defined- unable to clear duct/inflamed bile duct wall/treatment of complication/morbid patient)


Conversion rates <10%

Duct clearance rates > 85% (aim for > 90%)

Bile Leak Rates < 5% (defined as a leak of bile requiring intervention-additional procedure)

Returns to theatre < 5%

Readmission rates after elective and emergency cholecystectomy with LCBDE within 30 days <15%

Overall Morbidity < 15%

Overall Mortality  < 1%

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