Protocol driven management of suspected common duct stones: A Southwestern Surgical Congress multi-centered trial.

Abstract

BACKGROUND\nSeveral options exist for the diagnosis and management of suspected common duct stones. We hypothesized that a protocol-directed approach would shorten length of stay in this patient population.\n\n\nMETHODS\nPatients from four participating institutions with a peak bilirubin <4\u202fmg/dL underwent surgery as the initial procedure, whereas patients with a bilirubin ≥4\u202fmg/dL underwent endoscopy. The primary endpoint was length of stay. Analysis involved chi square and Wilcoxon-Mann-Whitney test with significance at p\u202f<\u202f0.05.\n\n\nRESULTS\n214 patients were managed under the protocol during six-month study period. 111 patients (52%) required endoscopy and surgery. Length of stay and the number of MRCPs performed pre-operatively significantly decreased following protocol implementation (p\u202f<\u202f0.05).\n\n\nCONCLUSIONS\n Surgery first approach in patients with bilirubin <4\u202fml/dL resulted in low morbidity and mortality, reduced MRCP, and length of stay.