Skip to main content

Advertisement

SpringerLink
Log in

A UK survey on variation in the practice of management of choledocholithiasis and laparoscopic common bile duct exploration (ALiCE Survey)

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

The practice of managing suspected/confirmed common bile duct stones (CBDS) can vary significantly in the UK. We aimed to assess this variability in practice and challenges to form a basis for future consensus.

Methods

An electronic survey containing 40 questions on various aspects of management of CBDS was sent to surgeons who perform cholecystectomies via five surgical associations.

Results

 A total of 132 surgeons responded to the survey. The speciality of surgeons includes upper gastro-intestinal (68%), general (18%), colorectal (12%), and others (2%). For patients with suspected CBD stones, 80% would choose magnetic resonance cholangio-pancreatography, and 14.4% would proceed to intra-operative imaging. Most surgeons preferred intra-operative cholangiogram over intra-operative ultrasound (83% vs 17%). For the treatment, 62.1% preferred a two-stage approach [endoscopic retrograde cholangio-pancreatography (ERCP) followed by laparoscopic cholecystectomy (LC)] and 33.4% chose a single-stage approach [LC + laparoscopic common bile duct exploration (LCBDE)]. Eighty (60.6%) responders performed LCBDE, and 19 (23.8%) of them performed > 10 LCBDEs in a year. Two third of surgeons (62.5%) preferred a trans-choledochal approach to CBDS. Half of the surgeons that perform LCBDE use a T-tube selectively and 1.6% routinely. The “availability of very good ERCP service” and “lack of formal training” were the two main reasons for surgeons not performing LCBDE. Both surgeons’ speciality and whether they perform other complex laparoscopic surgery were significantly associated with choosing a two-stage approach over a one-stage approach (χ2 test, speciality p = 0.033, complex surgery p = 0.011).

Conclusion

 Our survey confirms the significant variability in the diagnosis and management of CBDS. The two-stage approach is still the most common way of managing CBDS in the UK. The main reasons for the low uptake of the single-stage approach are the availability of good ERCP service, lack of equipment and lack of formal training in the technique of LCBDE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Dasari BV, Tan CJ, Gurusamy KS, Martin DJ, Kirk G, McKie L, Diamond T, Taylor MA (2013) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev CD003327

  2. Williams E, Beckingham I, El Sayed G, Gurusamy K, Sturgess R, Webster G, Young T (2017) Updated guideline on the management of common bile duct stones (CBDS). Gut 66:765–782

    Article  Google Scholar 

  3. Cox MR, Budge JP, Eslick GD (2015) Timing and nature of presentation of unsuspected retained common bile duct stones after laparoscopic cholecystectomy: a retrospective study. Surg Endosc 29:2033–2038

    Article  Google Scholar 

  4. Bansal VK, Misra MC, Garg P, Prabhu M (2010) A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones. Surg Endosc 24:1986–1989

    Article  Google Scholar 

  5. Vannijvel M, Lesurtel M, Bouckaert W, Houben B, Knol J, Vangertruyden G, Sergeant G (2016) A survey of European-African surgeons’ management of common bile duct stones. HPB (Oxford) 18:959–964

    Article  Google Scholar 

  6. Jorba R, Pavel MC, Llacer-Millan E, Estalella L, Achalandabaso M, Julia-Verdaguer E, Nve E, Padilla-Zegarra ED, Badia JM, O’Connor DB, Memba R (2021) Contemporary management of concomitant gallstones and common bile duct stones: a survey of Spanish surgeons. Surg Endosc 35:5024–5033

    Article  Google Scholar 

  7. Wandling MW, Hungness ES, Pavey ES, Stulberg JJ, Schwab B, Yang AD, Shapiro MB, Bilimoria KY, Ko CY, Nathens AB (2016) Nationwide Assessment of TRENDS IN CHOLEDOCHOLITHIASIS MANAGEMENT IN THE UNITED STATES FROM 1998 to 2013. JAMA Surg 151:1125–1130

    Article  Google Scholar 

  8. AUGIS Surgical Workload Outcomes Audit Database (SWORD) https://sword.methods.co.uk/login. Accessed 19 Apr 2021.

  9. Sanjay P, Kulli C, Polignano FM, Tait IS (2010) Optimal surgical technique, use of intra-operative cholangiography (IOC), and management of acute gallbladder disease: the results of a nation-wide survey in the UK and Ireland. Ann R Coll Surg Engl 92:302–306

    Article  CAS  Google Scholar 

  10. Jagtap N, Hs Y, Tandan M, Basha J, Chavan R, Nabi Z, Kalapala R, Reddy PM, Ramchandani M, Gupta R, Lakhtakia S, Darishetty S, Rao GV, Reddy DN (2020) Clinical utility of ESGE and ASGE guidelines for prediction of suspected choledocholithiasis in patients undergoing cholecystectomy. Endoscopy 52:569–573

    Article  Google Scholar 

  11. Manes G, Paspatis G, Aabakken L, Anderloni A, Arvanitakis M, Ah-Soune P, Barthet M, Domagk D, Dumonceau J-M, Gigot J-F, Hritz I, Karamanolis G, Laghi A, Mariani A, Paraskeva K, Pohl J, Ponchon T, Swahn F, Ter Steege RWF, Tringali A, Vezakis A, Williams EJ, van Hooft JE (2019) Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 51:472–491

    Article  Google Scholar 

  12. Committee ASoP, Buxbaum JL, Abbas Fehmi SM, Sultan S, Fishman DS, Qumseya BJ, Cortessis VK, Schilperoort H, Kysh L, Matsuoka L, Yachimski P, Agrawal D, Gurudu SR, Jamil LH, Jue TL, Khashab MA, Law JK, Lee JK, Naveed M, Sawhney MS, Thosani N, Yang J, Wani SB (2019) ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc 89:1075–1105 e1015

  13. Costi R, Gnocchi A, Di Mario F, Sarli L (2014) Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy. World J Gastroenterol 20:13382–13401

    Article  Google Scholar 

  14. Tranter SE, Thompson MH (2003) Spontaneous passage of bile duct stones: frequency of occurrence and relation to clinical presentation. Ann R Coll Surg Engl 85:174–177

    Article  CAS  Google Scholar 

  15. Lefemine V, Morgan RJ (2011) Spontaneous passage of common bile duct stones in jaundiced patients. Hepatobiliary Pancreat Dis Int 10:209–213

    Article  Google Scholar 

  16. CholeS Study Group WMRC (2016) Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases. Br J Surg 103:1716–1726

    Article  Google Scholar 

  17. Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 239:28–33

    Article  Google Scholar 

  18. Memba R, Gonzalez S, Coronado D, Gonzalez V, Mata F, Rodriguez JA, Muhlenberg C, Sala J, Ribas R, Pueyo E, Mata A, O’Connor DB, Conlon KC, Jorba R (2019) Single-stage approach for the management of choledocolithiasis with concomitant cholelithiasis. Implementation of a protocol in a secondary hospital. Surgeon 17:351–359

    Article  Google Scholar 

  19. Clout M, Blazeby J, Rogers C, Reeves B, Lazaroo M, Avery K, Blencowe NS, Vohra R, Jennings N, Hollingworth W, Thorn J, Jepson M, Collingwood J, Guthrie A, Booth E, Pathak S, Beckingham I, Culliford L, Griffiths EA, Albazaz R, Toogood G, Sunflower Study Executive G (2021) Randomised controlled trial to establish the clinical and cost-effectiveness of expectant management versus preoperative imaging with magnetic resonance cholangiopancreatography in patients with symptomatic gallbladder disease undergoing laparoscopic cholecystectomy at low or moderate risk of common bile duct stones (The Sunflower Study): a study protocol. BMJ Open 11:e044281

    Article  Google Scholar 

  20. Pan L, Chen M, Ji L, Zheng L, Yan P, Fang J, Zhang B, Cai X (2018) The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: an up-to-date meta-analysis. Ann Surg 268:247–253

    Article  Google Scholar 

  21. Baucom RB, Feurer ID, Shelton JS, Kummerow K, Holzman MD, Poulose BK (2016) Surgeons, ERCP, and laparoscopic common bile duct exploration: do we need a standard approach for common bile duct stones? Surg Endosc 30:414–423

    Article  Google Scholar 

  22. Jamal KN, Smith H, Ratnasingham K, Siddiqui MR, McLachlan G, Belgaumkar AP (2016) Meta-analysis of the diagnostic accuracy of laparoscopic ultrasonography and intraoperative cholangiography in detection of common bile duct stones. Ann R Coll Surg Engl 98:244–249

    Article  CAS  Google Scholar 

  23. Dili A, Bertrand C (2017) Laparoscopic ultrasonography as an alternative to intraoperative cholangiography during laparoscopic cholecystectomy. World J Gastroenterol 23:5438–5450

    Article  Google Scholar 

  24. Donoghue S, Jones RM, Bush A, Srinivas G, Bowling K, Andrews S (2020) Cost effectiveness of intraoperative laparoscopic ultrasound for suspected choledocholithiasis; outcomes from a specialist benign upper gastrointestinal unit. Ann R Coll Surg Engl 102:598–600

    Article  CAS  Google Scholar 

  25. Rogers SJ, Cello JP, Horn JK, Siperstein AE, Schecter WP, Campbell AR, Mackersie RC, Rodas A, Kreuwel HT, Harris HW (2010) Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg 145:28–33

    PubMed  Google Scholar 

  26. Reinders JS, Gouma DJ, Ubbink DT, van Ramshorst B, Boerma D (2014) Transcystic or transductal stone extraction during single-stage treatment of choledochocystolithiasis: a systematic review. World J Surg 38:2403–2411

    Article  Google Scholar 

  27. Hua J, Lin S, Qian D, He Z, Zhang T, Song Z (2015) Primary closure and rate of bile leak following laparoscopic common bile duct exploration via choledochotomy. Dig Surg 32:1–8

    Article  Google Scholar 

  28. Bekheit M, Smith R, Ramsay G, Soggiu F, Ghazanfar M, Ahmed I (2019) Meta-analysis of laparoscopic transcystic versus transcholedochal common bile duct exploration for choledocholithiasis. BJS Open 3:242–251

    Article  CAS  Google Scholar 

  29. Hunt DR (1996) Common bile duct stones in non-dilated bile ducts? An ultrasound study. Australas Radiol 40:221–222

    Article  CAS  Google Scholar 

  30. Chen H, Jorissen R, Walcott J, Nikfarjam M (2020) Incidence and predictors of common bile duct stones in patients with acute cholecystitis: a systematic literature review and meta-analysis. ANZ J Surg 90:1598–1603

    Article  Google Scholar 

  31. Huang XX, Wu JY, Bai YN, Wu JY, Lv JH, Chen WZ, Huang LM, Huang RF, Yan ML (2021) Outcomes of laparoscopic bile duct exploration for choledocholithiasis with small common bile duct. World J Clin Cases 9:1803–1813

    Article  Google Scholar 

  32. Campbell M (2015) Montgomery v Lanarkshire Health Board. Common Law World Rev 44:222–228

    Article  Google Scholar 

  33. Gurusamy KS, Koti R, Davidson BR (2013) T-tube drainage versus primary closure after laparoscopic common bile duct exploration. Cochrane Database Syst Rev CD005641

  34. Gurusamy KS, Samraj K (2007) Primary closure versus T-tube drainage after laparoscopic common bile duct stone exploration. Cochrane Database Syst Rev CD005641

  35. Gurusamy KS, Samraj K (2007) Primary closure versus T-tube drainage after open common bile duct exploration. Cochrane Database Syst Rev CD005640

  36. Lyon M, Menon S, Jain A, Kumar H (2015) Use of biliary stent in laparoscopic common bile duct exploration. Surg Endosc 29:1094–1098

    Article  Google Scholar 

  37. Dietrich A, Alvarez F, Resio N, Mazza O, de Santibanes E, Pekolj J, Claria RS, de Santibanes M (2014) Laparoscopic management of common bile duct stones: transpapillary stenting or external biliary drainage? JSLS 18

  38. Parra-Membrives P, Martinez-Baena D, Lorente-Herce J, Jimenez-Riera G (2018) comparative study of three bile duct closure methods following laparoscopic common bile duct exploration for choledocholithiasis. J Laparoendosc Adv Surg Tech A 28:145–151

    Article  Google Scholar 

  39. Abellán Morcillo I, Qurashi K, Abrisqueta Carrión J, Martinez Isla A (2014) Laparoscopic common bile duct exploration. Lessons learned after 200 cases. Cir Esp 92:341–347

    Article  Google Scholar 

  40. Nzenza TC, Al-Habbal Y, Guerra GR, Manolas S, Yong T, McQuillan T (2018) Recurrent common bile duct stones as a late complication of endoscopic sphincterotomy. BMC Gastroenterol 18:39

    Article  Google Scholar 

  41. Bergman JJGHM, Van Der Mey S, Rauws EAJ, Tijssen JGP, Gouma D-J, Tytgat GNJ, Huibregtse K (1996) Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. Gastrointest Endosc 44:643–649

    Article  CAS  Google Scholar 

  42. Ando T, Tsuyuguchi T, Okugawa T, Saito M, Ishihara T, Yamaguchi T, Saisho H (2003) Risk factors for recurrent bile duct stones after endoscopic papillotomy. Gut 52:116–121

    Article  CAS  Google Scholar 

  43. Paganini AM, Guerrieri M, Sarnari J, De Sanctis A, D’Ambrosio G, Lezoche G, Perretta S, Lezoche E (2007) Thirteen years’ experience with laparoscopic transcystic common bile duct exploration for stones Effectiveness and long-term results. Surg Endosc 21:34–40

    Article  CAS  Google Scholar 

  44. Waage A, Stromberg C, Leijonmarck CE, Arvidsson D (2003) Long-term results from laparoscopic common bile duct exploration. Surg Endosc 17:1181–1185

    Article  CAS  Google Scholar 

  45. Asuri K, Bansal VK, Bagaria V, Prajapati O, Kumar S, Ramachandran R, Garg P, Misra MC (2020) Long-term outcomes following primary closure of common bile duct following laparoscopic common bile duct (CBD) exploration: experience of 355 cases at a tertiary care center. Surg Laparosc Endosc Percutan Tech 30:504–507

    Article  Google Scholar 

  46. Yi HJ, Hong G, Min SK, Lee HK (2015) Long-term outcome of primary closure after laparoscopic common bile duct exploration combined with choledochoscopy. Surg Laparosc Endosc Percutan Tech 25:250–253

    Article  Google Scholar 

  47. Campbell-Lloyd AJ, Martin DJ, Martin IJ (2008) Long-term outcomes after laparoscopic bile duct exploration: a 5-year follow up of 150 consecutive patients. ANZ J Surg 78:492–494

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Peninsula HPB Unit, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK

    Andrei Tanase & Somaiah Aroori

  2. South West Liver Unit, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, UK

    Ashwin Dhanda & Matthew Cramp

  3. Peninsula Medical School (Faculty of Health), University of Plymouth, Plymouth, UK

    Andrei Tanase, Ashwin Dhanda, Matthew Cramp, Adam Streeter & Somaiah Aroori

Authors
  1. Andrei Tanase
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashwin Dhanda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Matthew Cramp
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adam Streeter
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Somaiah Aroori
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Somaiah Aroori.

Ethics declarations

Disclosures

Andrei Tanase, Ashwin Dhanda, Matthew Cramp, Adam Streeter and Somaiah Aroori have no conflict of interest to declare or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tanase, A., Dhanda, A., Cramp, M. et al. A UK survey on variation in the practice of management of choledocholithiasis and laparoscopic common bile duct exploration (ALiCE Survey). Surg Endosc 36, 5882–5896 (2022). https://doi.org/10.1007/s00464-021-08983-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08983-0

Keywords

Search

Navigation