Key Highlights:
Surgery-First vs. ERCP-First: The panel compares the two main management strategies: ERCP followed by laparoscopic cholecystectomy versus laparoscopic cholecystectomy with intraoperative cholangiogram (IOC) and stone removal.
Practice-Based Decision Making: Experts emphasize that choice depends on surgeon skill, institutional resources, and the ability to perform IOC effectively.
Clinical Evidence: Studies show an 86–90% success rate for ductal clearance using a surgery-first approach with IOC and flushing—offering a safe, resource-efficient option that minimizes ERCP-associated risks like pancreatitis.
Learning Curve & Equipment: Surgeons are encouraged to become more comfortable with intraoperative stone removal techniques. Having a prepared kit and standardized workflow is key to success.
ERCP Complications: While ERCP is effective, it carries a ~10% risk of complications including cholangitis and pancreatitis—making intraoperative solutions appealing when feasible.
This session underscores a shift toward empowering surgeons with tools and confidence to manage choledocholithiasis directly in the OR, improving outcomes and optimizing resource utilization across institutions.
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