Is There Common Ground? A Comparison of Laparoscopic Common Bile Duct Exploration by Acute Care Surgery and Minimally...

BackgroundLaparoscopic common bile duct exploration (LCBDE) is underutilized by surgeons to treat choledocholithiasis. We hypothesized that fellowship training in acute care surgery (ACS) vs minimally invasive surgery (MIS) results in different LCBDE practices and perceptions, thus producing unique barriers to implementation.MethodsA survey was distributed by email to members of Society of American Gastrointestinal and Endoscopic Surgeons and the American Association for the Surgery of Trauma to assess surgeon demographics, surgeon-specific perceptions, practice patterns, and barriers to LCBDE utilization. Categorical data were compared with Pearson's chi-square, and continuous parametric data were compared with a t test.Results543 US surgeons who perform laparoscopic cholecystectomy completed the survey. Of all, 124 survey respondents were ACS trained and 175 were MIS trained. Similar proportions of MIS and ACS surgeons prefer to manage choledocholithiasis with LCBDE (28% vs 27%, P = 0.79). The most utilized LCBDE technique was choledochoscopy (71% vs 69%, P = 0.17). MIS surgeons more frequently perform intraoperative cholangiogram (IOC) compared to ACS surgeons (P = 0.02). A third of MIS surgeons felt that LCBDE is too time consuming to be of value, vs 25% of ACS surgeons (P = 0.37). When asked if LCBDE is difficult to master, 56% of MIS surgeons agreed compared to 32% of ACS surgeons (P < 0.01).DiscussionBoth MIS and ACS surgeons utilize LCBDE infrequently despite responding that choledocholithiasis should be managed by surgeons. Compared to MIS, fewer ACS surgeons consider time to perform LCBDE and difficulty as barriers. Understanding these barriers can influence education and efforts toward increasing adoption in both groups.