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Making the Diagnosis: Surgery, a Rational Approach to the Patient with Suspected CBD Stones

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Multidisciplinary Management of Common Bile Duct Stones

Abstract

Common bile duct stones (CBDS) occur frequently in patients with gallstones and often are associated with pain, jaundice, sepsis, pancreatitis, and other potentially serious adverse outcomes. Some CBDS are asymptomatic, and others are occult. Safe and efficient management of CBDS requires a high index of suspicion during the preoperative evaluation, and a logical approach to the diagnostic assessment of symptomatic patients and those at high risk for occult CBDS. Preoperative identification and management of CBDS, in many settings, is superior to intraoperative or postoperative identification. Preoperative identification of CBDS provides maximal benefit for patients by allowing bile duct stones to be removed in advance of surgery, yielding the highest likelihood that laparoscopic cholecystectomy will be performed successfully, maintaining its minimally invasive benefits for patients. However, given the multitude of tests and techniques, the surgeon must coordinate an organized approach to the preoperative diagnosis of CBDS in order to remain cost-efficient. An algorithmic approach is advocated, one that uses noninvasive techniques initially, followed by increasingly invasive approaches to diagnosis and treatment. CBDS that are not detected preoperatively should be identified intraoperatively, when they can be addressed by intraoperative bile duct exploration or the use of adjacent techniques and technologies. It is least desirable for CBDS to be allowed to persist into the postoperative phase, where additional procedures and possible reoperation might be required, or when significant complications could develop related to retained CBDS.

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Author information

Authors and Affiliations

  1. Department of Surgery, The Guthrie Clinic, Sayre, PA, USA

    Robert D. Fanelli M.D., M.H.A., F.A.C.S. (Clinical Professor of Surgery, Professor of Surgery)

  2. The Commonwealth Medical College, Scranton, PA, USA

    Robert D. Fanelli M.D., M.H.A., F.A.C.S. (Clinical Professor of Surgery, Professor of Surgery)

  3. SUNY Upstate Medical University, Binghamton, NY, USA

    Robert D. Fanelli M.D., M.H.A., F.A.C.S. (Clinical Professor of Surgery, Professor of Surgery)

  4. Albany Medical College, Albany, NY, USA

    Robert D. Fanelli M.D., M.H.A., F.A.C.S. (Clinical Professor of Surgery, Professor of Surgery)

  5. Department of Surgery, The Guthrie Robert Packer Hospital Residency Program in Surgery, Sayre, PA, USA

    Brandon D. Andrew M.D.

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  1. Robert D. Fanelli M.D., M.H.A., F.A.C.S.
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  2. Brandon D. Andrew M.D.
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Editors and Affiliations

  1. The Ohio State University Wexner Medical Center, Chief, Division of General and Gastrointestinal Surgery,, Department of Surgery,, Columbus, Ohio, USA

    Jeffrey W. Hazey

  2. The Ohio State University Wexner Medical Center, Director, Division of Gastroenterology, Hepatology, and Nutrition, Professor of Medicine, Department of Internal Medicine,, Columbus, Ohio, USA

    Darwin L. Conwell

  3. The Ohio State University Wexner Medical Center, Division of Vascular and Interventional Radiology, Department of Radiology, Columbus, Ohio, USA

    Gregory E. Guy

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Fanelli, R.D., Andrew, B.D. (2016). Making the Diagnosis: Surgery, a Rational Approach to the Patient with Suspected CBD Stones. In: Hazey, J., Conwell, D., Guy, G. (eds) Multidisciplinary Management of Common Bile Duct Stones. Springer, Cham. https://doi.org/10.1007/978-3-319-22765-8_5

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  • DOI: https://doi.org/10.1007/978-3-319-22765-8_5

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-22764-1

  • Online ISBN: 978-3-319-22765-8

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