Is It Time to Re-Embrace the Art?
Hodgson and Bird’s editorial distills the case for surgical duct clearance into two categories. Contemporary ERCP complication rates of roughly 8% for pancreatitis, 5% for cholangitis, and 9% for recurrent duct stones, plus the permanent consequences of sphincterotomy including duodenobiliary reflux and long-term stricture risk. The second approach is transcystic exploration clearing over 90% of ducts in routinely reported series, with the sphincter of Oddi intact and the entire episode of care completed under one anesthetic. Their economic argument is that single-stage care eliminates the inpatient days, transfers, and repeat admissions built into two-stage pathways.
Citation
Hodgson R, Bird DL. Is it time to re-embrace the art of common bile duct exploration? ANZ J Surg. 2022;92(6):1304-1305. doi:10.1111/ans.17376
