Reclaim the Duct!
Cironi and Martin’s review is both a manifesto and a manual. The manifesto: with bile duct stones complicating 10-15% of cholecystectomies and network meta-analysis of more than 8,000 patients showing single-stage management yields shorter stays and lower complication rates, acute care surgeons should “reclaim the duct.” The manual: a complete transcystic step-up technique — wire access, cystic duct dilation, choledochoscopy, lithotripsy, balloon sphincteroplasty — favoring the transcystic route for its shorter operative times and fewer complications. Their honest accounting of barriers (limited training exposure, consult patterns that bypass surgery, and gaps in the equipment ecosystem) reads as a to-do list for surgical education and for industry alike.
Citation
Cironi K, Martin MJ. Reclaim the duct! Laparoscopic common bile duct exploration for the acute care surgeon. Trauma Surg Acute Care Open. 2025;10:e001821. doi:10.1136/tsaco-2025-001821
