Even at 2 AM, One Stage Wins
A practical objection to single-stage duct management is that it can’t be done when patients actually present on nights and weekends. Stettler and colleagues evaluated patients undergoing cholecystectomy with transcystic LCBDE (wire-guided antegrade balloon sphincteroplasty) Length of stay was 48 hours versus 86 hours for the ERCP-based pathway (P<.01). Nighttime cases succeeded as often as daytime cases (68% vs 71%) with identical operative times, and even a failed nighttime exploration requiring rescue ERCP produced a stay no longer than a successful daytime case. With one minor complication in the entire series, the authors’ conclusion holds: attempting the single-stage approach is a no-regret move, around the clock.
Citation
Stettler GR, Ganapathy AS, Bosley ME, et al. Win or lose, nighttime transcystic laparoscopic common bile duct exploration is a win. Trauma Surg Acute Care Open. 2023;8:e001045. doi:10.1136/tsaco-2022-001045
