Question:
A patient has multiple gallstones and imaging shows 8 mm dilatation with 4 stones in the common bile duct (CBD). The best treatment modality is:
A patient has multiple gallstones and imaging shows 8 mm dilatation with 4 stones in the common bile duct (CBD). The best treatment modality is:
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One-stage clearance of both gallbladder and duct is preferred when expertise allows.
Updated On: Jun 23, 2026
- Cholecystectomy with choledocholithotomy at the same setting
- ESWL
- Cholecystectomy and wait for ERCP
- All
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The Correct Option is A
Solution and Explanation
Step 1: For gallbladder stones, laparoscopic cholecystectomy is the procedure of choice.
Step 2: For associated CBD stones, an experienced laparoscopic surgeon can clear the duct in the same sitting: CBD stones are confirmed on intraoperative cholangiogram, then removed laparoscopically via the cystic duct or by choledochotomy.
Step 3: If the surgeon is not experienced in laparoscopic CBD clearance, preoperative endoscopic sphincterotomy with stone removal followed by laparoscopic cholecystectomy is the alternative.
Conclusion: When feasible, cholecystectomy with choledocholithotomy at the same setting is the preferred single-stage management. ESWL is not a standard CBD stone treatment, so the best answer is option a.
Ref: Maingot's Abdominal Operations.
Step 2: For associated CBD stones, an experienced laparoscopic surgeon can clear the duct in the same sitting: CBD stones are confirmed on intraoperative cholangiogram, then removed laparoscopically via the cystic duct or by choledochotomy.
Step 3: If the surgeon is not experienced in laparoscopic CBD clearance, preoperative endoscopic sphincterotomy with stone removal followed by laparoscopic cholecystectomy is the alternative.
Conclusion: When feasible, cholecystectomy with choledocholithotomy at the same setting is the preferred single-stage management. ESWL is not a standard CBD stone treatment, so the best answer is option a.
Ref: Maingot's Abdominal Operations.
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