Question:medium
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
Frame this as a single-stage versus two-stage choice. ESWL is for renal and select pancreatic stones, not a recommended modality for CBD calculi, so rule it out. Waiting for a separate ERCP after cholecystectomy splits care into two procedures and is a fallback when laparoscopic duct clearance is not available. The ideal, when the surgeon is skilled in laparoscopic CBD techniques, is to remove the gallbladder and clear the 4 ductal stones in one sitting: intraoperative cholangiogram confirms the stones, then transcystic or choledochotomy extraction clears them. One anaesthesia, one admission, definitive treatment. Therefore cholecystectomy with choledocholithotomy at the same setting is the best answer.
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