Stepwise Strategies for Managing Common Bile Duct Stones in Patients Undergoing Cholecystectomy: A Comprehensive Review

Choledocholithiasis occurs in approximately 10-20% of patients with gallstones and can lead to severe complications, including obstructive jaundice, acute cholangitis, and acute pancreatitis. This review evaluates the diagnostic and therapeutic approaches for choledocholithiasis in patients scheduled for cholecystectomy. Diagnosis is based on clinical history, laboratory tests, ultrasonography, endoscopic ultrasound, and magnetic resonance cholangiopancreatography. Management strategies include the one-step approach, combining laparoscopic cholecystectomy and bile duct exploration, and the two-step approach, performing endoscopic retrograde cholangiopancreatography (ERCP) before cholecystectomy. The one-step approach offers advantages such as shorter hospitalization but requires experienced surgeons. The two-step approach is more suitable for patients with acute cholangitis, pancreatitis, narrow bile ducts, impacted stones, or multiple stones. In South Korea, the two-step approach is predominantly favored due to the widespread availability of advanced endoscopic techniques and the expertise of gastroenterologists. ERCP is highly standardized and effective for biliary drainage, particularly in emergency settings. Effective management of choledocholithiasis requires a tailored approach that considers patient condition, stone characteristics, and available resources. Collaboration between gastroenterologists and surgeons is critical to achieving optimal outcomes. Further research, particularly large-scale multicenter studies, is necessary to refine treatment guidelines and improve patient care.