Preoperative Decision-Making Algorithm

  • Arslan Pannu
  • Ahmad Mirza


The diagnosis and management of common bile duct stones requires a thorough approach, which can often be challenging. Pathways for the diagnosis and management of suspected common bile duct stone patients presenting with distinct syndromes are presented to facilitate safe clinical practice. All patients with acute uncomplicated gallstone pancreatitis should be offered operative intervention at the index admission. Patients with severe or complicated pancreatitis should be stabilized and undergo delayed interval cholecystectomy once they have recovered. Acute cholangitis can manifest as mild, moderate, or severe disease. Endoscopic biliary decompression should be performed in all patients who fail to improve or are acutely unwell. Laparoscopic cholecystectomy should be considered in all cases of gallstone-related acute cholangitis to reduce long-term morbidity and mortality. Management of choledocholithiasis in patients with altered anatomy is complex and requires an individualized plan, and consultation with or transfer to a specialist center may be helpful. All patients with jaundice should be thoroughly investigated to identify underlying pathology and to initiate appropriate treatment. A single-session laparoscopic approach, incorporating routine intraoperative imaging and expertise in laparoscopic common bile duct exploration where available, facilitates the management of choledocholithiasis.


Choledocholithiasis Intraoperative cholangiogram Pancreatitis Jaundice Cholangitis Laparoscopic ultrasound Laparoscopic bile duct exploration Single-session management 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Colorectal/General SurgeryThe Royal Oldham HospitalManchesterUK
  2. 2.Department of General SurgeryThe Pennine Acute Hospitals NHS TrustManchesterUK

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