Protocol Driven Management of Suspected Common Duct Stones: A Southwestern Surgical Congress Multi-Centered Trial

Abstract Background Several 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. Methods Patients from four participating institutions with a peak bilirubin Results 214 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 Conclusions “Surgery first” approach in patients with bilirubin