Invited Critique |

One-Stage Treatment for CBDS Discovered During Laparoscopic Cholecystectomy Is Not Practical:  Comment on “Treatment for Retrieved Common Bile Duct Stones During Laparoscopic Cholecystectomy”

E. Christopher Ellison, MD
Arch Surg. 2010;145(12):1149-1150. doi:10.1001/archsurg.2010.262.
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Borzellino and colleagues add to the increasingly strong level I and II evidence supporting single-stage treatment of CBDS detected during laparoscopic cholecystectomy.1 Common bile duct stones are found in 10% to 15% of the 770 000 patients who have elective cholecystectomy each year. Treatment includes 1- or 2-stage management. Options for the 1-stage approach include (1) laparoscopic or open common bile duct exploration (LCBDE or OCBDE) via the cystic duct or choledochotomy or (2) intraoperative endoscopic retrograde stone extraction, which may be facilitated by the rendezvous technique. Two-stage management of CBDS is deferred to the postoperative period and requires endoscopic retrograde stone extraction. Most studies support the 1-stage approach, showing equivalent or superior successful stone extraction, reduced length of stay, less morbidity and reduction of the need for multiple procedures. It would seem that surgeons would adopt this approach.

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