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Preoperative Decision-Making Algorithm

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Choledocholithiasis

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Abstract

The diagnosis and management of common bile duct stones requires a thorough approach, which can often be challenging. Pathways for the diagnosis and management of suspected common bile duct stone patients presenting with distinct syndromes are presented to facilitate safe clinical practice. All patients with acute uncomplicated gallstone pancreatitis should be offered operative intervention at the index admission. Patients with severe or complicated pancreatitis should be stabilized and undergo delayed interval cholecystectomy once they have recovered. Acute cholangitis can manifest as mild, moderate, or severe disease. Endoscopic biliary decompression should be performed in all patients who fail to improve or are acutely unwell. Laparoscopic cholecystectomy should be considered in all cases of gallstone-related acute cholangitis to reduce long-term morbidity and mortality. Management of choledocholithiasis in patients with altered anatomy is complex and requires an individualized plan, and consultation with or transfer to a specialist center may be helpful. All patients with jaundice should be thoroughly investigated to identify underlying pathology and to initiate appropriate treatment. A single-session laparoscopic approach, incorporating routine intraoperative imaging and expertise in laparoscopic common bile duct exploration where available, facilitates the management of choledocholithiasis.

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Authors and Affiliations

  1. Department of Colorectal/General Surgery, The Royal Oldham Hospital, Manchester, UK

    Arslan Pannu MBBS, MRCS

  2. Department of General Surgery, The Pennine Acute Hospitals NHS Trust, Manchester, UK

    Ahmad Mirza MD, FRCS

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  1. Arslan Pannu MBBS, MRCS
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  2. Ahmad Mirza MD, FRCS
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Correspondence to Ahmad Mirza MD, FRCS .

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Editors and Affiliations

  1. Dartmouth College, Geisel School of Med, Hanover, New Hampshire, USA

    B. Fernando Santos

  2. Northwestern University, Chicago, Illinois, USA

    Nathaniel Soper

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Pannu, A., Mirza, A. (2018). Preoperative Decision-Making Algorithm. In: Santos, B., Soper, N. (eds) Choledocholithiasis . Springer, Cham. https://doi.org/10.1007/978-3-319-74503-9_3

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  • DOI: https://doi.org/10.1007/978-3-319-74503-9_3

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