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Acute Cholecystitis pp 169–186Cite as

Management of Choledocholithiasis

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Abstract

Choledocholithiasis refers to gallstones within the biliary tree, most commonly from the gallbladder. Most cases of choledocholithiasis are asymptomatic, and are diagnosed during the course of the workup of cholelithiasis by a combination of laboratory and imaging derangements. A minority of cases of choledocholithiasis present as either ascending cholangitis or acute gallstone pancreatitis (or both). Regardless of symptoms, our approach is one of routine clearance of the biliary tree if choledocholithiasis has been found. There are many accepted means to achieve stone clearance. In this chapter, we will discuss these methods and our preferred method, the “single-stage” approach, which involves totally laparoscopic cholecystectomy, interrogation of the biliary tree (by both ultrasound and cholangiography), and, if necessary, common bile duct exploration. Endoscopic techniques, such as retrograde cholangiopancreatography, remain an important adjunct to each approach, and are used as first-line therapy in patients believed to be at higher risk for immediate surgical intervention (e.g., cholangitis and pancreatitis) or who have impacted common bile duct stones with anticipated difficult removal. Finally, there remains a role for open surgical management of choledocholithiasis, primarily when larger (>10 mm) stones are present. In this case, surgeons must be proficient in the techniques of common bile duct exploration, choledochoenterostomy, and transduodenal sphincterotomy.

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Authors and Affiliations

  1. Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St., Denver, CO, USA

    Fredric M. Pieracci M.D., M.P.H.

  2. Denver Health Medical Center; MS4, Saint Louis University School of Medicine, 1207A MacKay Pl, Saint Louis, MO, USA

    Brant M. Jaouen

  3. Kaiser Permanente, Denver, CO, USA

    Robert T. Stovall M.D.

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  1. Fredric M. Pieracci M.D., M.P.H.
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  2. Brant M. Jaouen
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  3. Robert T. Stovall M.D.
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Correspondence to Fredric M. Pieracci M.D., M.P.H. .

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  1. Department of Surgery, Weill Cornell Medical College, New York, New York, USA

    Soumitra R. Eachempati

  2. Department of Surgery, Indiana University Acute Care Surgery, Indiana University Health Methodist Hospital, Indianapolis, Indiana, USA

    R. Lawrence Reed, II

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Pieracci, F.M., Jaouen, B.M., Stovall, R.T. (2015). Management of Choledocholithiasis. In: Eachempati, S., Reed, II, R. (eds) Acute Cholecystitis. Springer, Cham. https://doi.org/10.1007/978-3-319-14824-3_14

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