title: Management of common bile duct stones in a rural area of the United States: results of a survey.
abstract: BACKGROUND
  Laparoscopic common bile duct exploration has been reported to be highly successful and cost-effective. It remains unknown to what extent the procedure is used in routine surgical practice.
  
  
  METHODS
  We conducted a survey of general surgeons practicing in a rural area of the United States. The type of practice, laparoscopic training, performance of cholangiography, and preferred approach to choledocholithiasis were elicited.
  
  
  RESULTS
  Sixty-eight of 207 surveys (33%) were returned. Thirty respondents (45%) indicated that they perform laparoscopic common bile duct explorations. The likelihood of laparoscopic common bile duct exploration increased with a higher number of cholecystectomies per year (p < 0.05, chi-square) but was independent of training or routine cholangiography. The preferred approach to a patient with choledocholithiasis was endoscopic retrograde cholangiopancreatography (75%), followed by laparoscopic (21%) and open exploration (4%). Reasons for not performing laparoscopic exploration were time (58%), equipment (24%), good gastrointestinal backup (6%), reimbursement (3%), increased morbidity (1.5%), lack of skill (1.5%), and other/no reason (18%).
  
  
  CONCLUSIONS
  Although 45% of practicing surgeons indicated that they perform laparoscopic common bile duct explorations, only 21% practiced it as their preferred approach. Time constraints and lack of equipment are the main factors preventing the application of the laparoscopic technique toward choledocholithiasis.
authors.affiliation: Department of Surgery, University of Texas Health Science Center, San Antonio, TX 78229-3900, USA. bingenercas@uthscsa.edu
authors.forename: J
authors.initials: J
authors.lastname: Bingener
authors.forename: W H
authors.initials: WH
authors.lastname: Schwesinger
mesh_terms: D001662:Biliary Tract Surgical Procedures; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000601:surgery*; D003625:Data Collection; D006801:Humans; D011364:Professional Practice; D012424:Rural Population; D013781:Texas