Aim: To provide the acute care surgeon with an overview, technical description, and discussion of the benefits of laparoscopic common bile duct exploration to promote surgically focused care of gallstone disease.
Background: Gallstone disease is one of the most common surgical conditions worldwide. Choledocholithiasis imparts specific management concerns and challenges. Currently, most suspected choledocholithiasis is managed via a two-stage approach by clearing the biliary tree preoperatively, followed by laparoscopic cholecystectomy (LC). Laparoscopic common bile duct exploration (LCBDE) is an attractive, one-stage surgical approach to manage choledocholithiasis; however, it has become a lost skill for modern surgeons. Transcystic (TC) LCBDE has been shown to be as successful as alternative methods and offers a low complication rate and short length of hospital stay.
Clinical significance: Although most surgeons do not currently perform LCBDE, surgically focused care of choledocholithiasis promotes improved patient care through a single anesthetic and low complication rate. Surgeons and hospital systems also benefit from increased surgical expertise, shorter length of hospital stay, and potentially decreased costs.
Conclusion: Surgeons and systems should focus on shifting the balance toward surgically based care for the management of suspected and confirmed choledocholithiasis. The review focuses on strategies to promote a surgery-first approach to choledocholithiasis.
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