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Contemporary management of concomitant gallstones and common bile duct stones: a survey of Spanish surgeons

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Abstract

Background

Concomitant gallstones and common bile duct stones (CBDS) is a relatively frequent presentation. The optimal treatment remains controversial and the debate persists between two strategies. The one-stage approach: laparoscopic cholecystectomy with laparoscopic common bile duct exploration (LCBDE) has been shown to be equally safe and more cost-effective than the more traditional two-stage approach: endoscopic retrograde cholangiography followed by laparoscopic cholecystectomy (ERCP + LC). However, many surgeons worldwide still prefer the two-stage procedure. This survey evaluated contemporary management of CBDS in Spain and assessed the impact of surgeon and hospital factors on provision of LCBDE.

Methods

A 25-item, web-based anonymous survey was sent to general surgeons members of the Spanish Surgeons Association. Descriptive statistics were applied to summarize results.

Results

Responses from 305 surgeons across 173 Spanish hospitals were analyzed. ERCP is the initial approach for preoperatively suspected CBDS for 86% of surgeons. LCBDE is the preferred method for only 11% of surgeons and only 11% treat more than 10 cases per year. For CBDS discovered intraoperatively, 59% of respondents attempt extraction while 32% defer to a postoperative ERCP. The main reasons cited for not performing LCBDE were lack of equipment, training and timely availability of an ERCP proceduralist. Despite these barriers, most surgeons (84%) responded that LCBDE should be implemented in their departments.

Conclusions

ERCP was the preferred approach for CBDS for the majority of respondents. There remains limited use of LCBDE despite many surgeons indicating it should be implemented. Focused planning and resourcing of both training and operational demands are required to facilitate adoption of LCBDE as option for patients.

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Acknowledgements

The authors would like to express our deep gratitude to all the doctors who responded to the survey. Collaborators: Asociación Española de Cirujanos AEC.

Funding

The resources and the facilities available at the Department of Surgery, University Hospital of Tarragona Joan XXIII were used to conduct this study. No additional funding source was used.

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Authors and Affiliations

  1. Department of Abdominal and General Surgery, Hospital Universitari de Tarragona, Joan XXIII, Dr Mallafre Guasch, 4, 43005, Tarragona, Spain

    Rosa Jorba, Mihai C. Pavel, Erik Llàcer-Millán, Laia Estalella, Mar Achalandabaso, Elisabet Julià-Verdaguer, Erlinda D. Padilla-Zegarra & Robert Memba

  2. Department of General Surgery, Hospital de Granollers, Granollers, Spain

    Esther Nve & Josep M. Badia

  3. Department of Surgery, School of Medicine, Trinity College Dublin, Dublin 2, Ireland

    Donal B. O’Connor

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Contributions

RJ and RM performed the survey and wrote the paper; MP, EDP-Z and EL contributed to the conception and design of the study, acquisition of data, analysis and interpretation of data. EN, JMB, LE, EJ, MA and DBO’ contributed to critical revision of the manuscript. All authors have participated in drafting the article or revising it critically for important intellectual content and all authors have given final approval of this version to be published.

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Correspondence to Rosa Jorba.

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Jorba R, Pavel M, Llàcer E, Padilla-Zegarra ED, Nve E, Badia JM, Estalella L, Julià E, Achalandabaso M, O’Connor DB and Memba R have no conflicts of interest or financial ties to disclose.

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Jorba, R., Pavel, M.C., Llàcer-Millán, E. et al. Contemporary management of concomitant gallstones and common bile duct stones: a survey of Spanish surgeons. Surg Endosc 35, 5024–5033 (2021). https://doi.org/10.1007/s00464-020-07984-9

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