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. 2024 Nov;38(11):6753-6761.
doi: 10.1007/s00464-024-11146-6. Epub 2024 Aug 14.

Moving the needle for laparoscopic common bile duct exploration: defining obstacles for the path forward

Maggie E Bosley  1 , Gabriel E Cambronero  2 , Gloria D Sanin  2 , Elizabeth C Wood  2 , Lucas P Neff  2 , B Fernando Santos  3 , Ranjan Sudan  4
Affiliations

Moving the needle for laparoscopic common bile duct exploration: defining obstacles for the path forward

Maggie E Bosley et al. Surg Endosc. 2024 Nov.

Abstract

Introduction: Laparoscopic cholecystectomy is performed very commonly but laparoscopic common bile duct exploration (LCBDE) is performed infrequently. We aimed to determine the most significant barriers to performing LCBDE and to identify the highest yield interventions to facilitate adoption.

Methods and procedures: A national survey was designed by content experts, who regularly perform LCBDE. The survey was distributed by email to the Society of American Gastrointestinal and Endoscopic Surgeons and the American Association for the Surgery of Trauma memberships. Non-U.S. surgeon responses were excluded. Descriptive statistics were used to analyze the results.

Results: Seven hundred twenty six practicing surgeons responded to the survey, 543 of which were US surgeons who perform laparoscopic cholecystectomy. Only 27% of respondents preferred to manage choledocholithiasis with LCBDE. Their technique of choice was choledochoscopy (70%). Despite this, 36% of surgeons did not have access to a choledochoscope or were unsure if they did. Seventy percent of surgeons who performed LCBDE did not have supplies readily available in a central stocking location. Only 8.5% of surgeons agreed that routine LCBDE would impact their referral relationship with gastroenterology. About half the respondents (47%) considered LCBDE worth the time, but only 25% knew about reimbursement for the procedure. Almost all (85%) of surgeons understood that LCBDE results in shorter length of stay compared to ERCP.

Conclusions: Only a quarter of the surgeons performing cholecystectomy perform LCBDE. Multiple barriers contribute to low LCBDE utilization. Increasing availability of appropriate equipment, a dedicated supply cart, and teaching fluoroscopic LCBDE interventions may address limitations and increase adoption. These efforts may also increase efficiency, minimizing perceived time and skill restraints. Although many surgeons understand LCBDE decreases length of stay, they are unaware of surgeon-specific LCBDE financial benefits. Systematically addressing these barriers may increase LCBDE adoption, improve patient care, and decrease healthcare costs.

Keywords: Cholangiogram; Cholecystectomy; Choledocholithiasis; Laparoscopic common bile duct exploration.

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References

    1. Shaffer EA (2006) Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol 20(6):981–996. https://doi.org/10.1016/j.bpg.2006.05.004 - DOI - PubMed
    1. Wandling MW, Hungness ES, Pavey ES et al (2016) Nationwide assessment of trends in choledocholithiasis management in the United States from 1998 to 2013. JAMA Surg 151(12):1125–1130. https://doi.org/10.1001/jamasurg.2016.2059 - DOI - PubMed
    1. Topal B, Vromman K, Aerts R, Verslype C, Van Steenbergen W, Penninckx F (2010) Hospital cost categories of one-stage versus two-stage management of common bile duct stones. Surg Endosc 24(2):413–416. https://doi.org/10.1007/s00464-009-0594-0 - DOI - PubMed
    1. Short SS, Frykman PK, Nguyen N, Liu Q, Berel D, Wang KS (2013) Laparoscopic common bile duct exploration in children is associated with decreased cost and length of stay: results of a two-center analysis. J Pediatr Surg 48(1):215–220. https://doi.org/10.1016/j.jpedsurg.2012.10.041 - DOI - PubMed
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381. https://doi.org/10.1016/j.jbi.2008.08.010 - DOI - PubMed

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