Background: Choledocholithiasis is present in up to 15% of cholecystectomy patients. Treatment can be surgical, endoscopic, or via interventional radiology. We hypothesized significant heterogeneity between hospitals exists in the approach to suspected common duct stones. Methods: A retrospective review of patients that had a preoperative MRCP, endoscopic ultrasound, endoscopic retrograde cholangiopancreatogram (ERCP), or intra-operative cholangiogram was performed. Comparisons were by Wilcoxon-Mann-Whitney tests with significance of p < 0.05 for paired variables and p < 0.017 for multiple comparisons. Results: Twelve participating institutions identified 1263 patients (409 men and 854 women)with a median age of 49 years (IQR: 31–94). Liver function tests (LFT's)were elevated in 939 patients (75%), median bilirubin level 1.75 mg/dl (IQ: 0.8–3.7 mg/dl)and median common duct size 7 mm (IQR 5–10 mm). The most common initial procedure was cholecystectomy with IOC at seven institutions, endoscopy at four and MRCP at one. Conclusion: Significant variation exists within the surgical community regarding suspected common duct stones. These results underscore the need for a protocol for common duct stones to minimize multiple, redundant interventions.
- Common duct exploration
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