Surgeons, ERCP, and laparoscopic common bile duct exploration: do we need a standard approach for common bile duct stones?

摘要: Variation exists in the management of choledocholithiasis (CDL). This study evaluated associations between demographic and practice-related characteristics CDL management. A 22-item, web-based survey was administered to US general surgeons. Respondents were classified into metropolitan or nonmetropolitan groups by zip code. Univariate tests multivariable logistic regression used determine factors associated with preferences. The sent 32,932 surgeons; 9902 performed laparoscopic cholecystectomy within last year; 750 771 respondents had a valid code included analysis. Mean practice time 18 ± 10 years, 87 % male, 83 % practiced area. For preoperatively known CDL, 86 % chose preoperative endoscopic retrograde cholangiopancreatography (ERCP). Those areas more likely select ERCP than those (88 vs. 79 %, p < 0.001). discovered intraoperatively, 30 % selected common bile duct exploration (LCBDE) as their preferred method no difference (30 26 %, p = 0.335). top reasons for not performing LCBDE were: having reliable proceduralist available, lack equipment, comfort LCBDE. Factors status, selective intraoperative cholangiography (IOC), availability proceduralist. who perform IOC 70 % less prefer (OR 0.32, 95 % CI 0.18–0.57, available 90 % 0.10, 0.04–0.26, majority CDL. Having use IOC, status independently ERCP. Postoperative managing intraoperatively Many surgeons are uncomfortable LCBDE, increased training may be needed.