Contemporary management of concomitant gallstones and common bile duct stones: a survey of Spanish surgeons
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and Other Interventional Techniques
Contemporary management of concomitant gallstones and common bile duct stones: a survey of Spanish surgeons Rosa Jorba1 · Mihai C. Pavel1 · Erik Llàcer‑Millán1 · Laia Estalella1 · Mar Achalandabaso1 · Elisabet Julià‑Verdaguer1 · Esther Nve2 · Erlinda D. Padilla‑Zegarra1 · Josep M. Badia2 · Donal B. O’Connor3 · Robert Memba1 Received: 5 June 2020 / Accepted: 14 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Concomitant gallstones and common bile duct stones (CBDS) is a relatively frequent presentation. The optimal treatment remains controversial and the debate persists between two strategies. The one-stage approach: laparoscopic cholecystectomy with laparoscopic common bile duct exploration (LCBDE) has been shown to be equally safe and more cost-effective than the more traditional two-stage approach: endoscopic retrograde cholangiography followed by laparoscopic cholecystectomy (ERCP + LC). However, many surgeons worldwide still prefer the two-stage procedure. This survey evaluated contemporary management of CBDS in Spain and assessed the impact of surgeon and hospital factors on provision of LCBDE. Methods A 25-item, web-based anonymous survey was sent to general surgeons members of the Spanish Surgeons Association. Descriptive statistics were applied to summarize results. Results Responses from 305 surgeons across 173 Spanish hospitals were analyzed. ERCP is the initial approach for preoperatively suspected CBDS for 86% of surgeons. LCBDE is the preferred method for only 11% of surgeons and only 11% treat more than 10 cases per year. For CBDS discovered intraoperatively, 59% of respondents attempt extraction while 32% defer to a postoperative ERCP. The main reasons cited for not performing LCBDE were lack of equipment, training and timely availability of an ERCP proceduralist. Despite these barriers, most surgeons (84%) responded that LCBDE should be implemented in their departments. Conclusions ERCP was the preferred approach for CBDS for the majority of respondents. There remains limited use of LCBDE despite many surgeons indicating it should be implemented. Focused planning and resourcing of both training and operational demands are required to facilitate adoption of LCBDE as option for patients. Keywords Endoscopic retrograde cholangiopancreatography (ERCP) · Laparoscopic common bile duct exploration (LCBDE) · Common bile duct stones · Laparoscopic cholecystectomy · Choledocholithiasis · Choledochoscope · Survey Cholelithiasis is a common disorder all over the world with a substantial burden to health care systems. The prevalence varies widely by region from 5 to 20 per cent in the general population. More than 20% of patients with cholelithiasis develop symptoms or complications [1–3]. The gold standard treatment for symptomatic gallbladder stones is laparoscopic cholecystectomy (LC), which is the most frequently performed operation of the digestive tract [4]. Concomitant gallstones and common bile duct stone
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