Choledocholithiasis Is a Surgical Disease
Conner and colleagues describe the modern blueprint for surgeon-led bile duct stone care: a standardized, acute-care-surgery-driven “surgery first — one stop” LCBDE pathway. Across 126 explorations, full adoption of the pathway improved duct clearance from 70.6% to 87.0% (P=.04) without lengthening the operation, cut median length of stay from 72 to 40 hours (P=.01), and delivered a 3.1% complication rate with 2.4% 30-day readmissions. The accompanying discussion at a national surgical meeting highlighted a telling gap: asked about antegrade stenting, the authors confirmed they currently use none, the prior commercial stent having left the market. The pathway is proven; the instrumentation is still incomplete.
Citation
Conner J, Stettler G, Gomez M, et al. Choledocholithiasis is a surgical disease: the evolution, standardization, and impact of laparoscopic common bile duct exploration in the acute care surgery setting. J Am Coll Surg. Published online 2026. doi:10.1097/XCS.0000000000001815
