Management of intraoperatively identified small bile duct stones in patients undergoing cholecystectomy

• DOI: 10.1007/s00423-024-03260-9
• Publication Date: 2024-02-22T06:03:50Z
• Authors: David Bunting; Abidemi Adesuyi; John Findlay; Maciej Pawlak; David Sanders
• Keywords: Expectant management

Abstract Introduction The management of CBDS (common bile duct stones) in patients with co-existing gallbladder stones has been debated. Guidelines recommend identified on imaging should be offered clearance; however, this is based low-quality evidence. This study aimed to investigate the natural history small using IOUS (intraoperative ultrasound) undergoing cholecystectomy. may provide evidence support a short-term expectant approach such patients. Methods Patients diagnosed during cholecystectomy were from database consecutive surgery. divided into stone (SS, ≤5 mm) and large (LS, >5 groups. Intraoperative management, postoperative investigations, clearance, re-admissions, complications, length stay (LOS) follow-up are described. Results Fifty-nine 427 had IOUS. In SS group ( n =51), 46 underwent rather than immediate/planned clearance. Following 41/46 (89.1%) did not require endoscopic retrograde cholangiopancreatography at >3 year follow-up, none since presented residual CBDS. Median LOS was 0 days 2 clearance group, P= 0.039. Conclusions reports Such safely treated associated reduced hospital LOS. provides rationale for undertaking further research establish as preferred strategy.