Prospective Validation of "Cholecystectomy First" Strategy for Gallstone Migration
Prospective Validation of "Cholecystectomy First" Strategy for Gallstone Migration
Initial cholecystectomy with intraoperative cholangiogram, followed if required by ERCP, has
 been implemented at the investigators institution as the standard management strategy for
 patients at intermediate risk of common bile duct stone migration, following a randomized
 controlled trial previously published by the same investigators team. The aim of this study
 is to prospectively analyze the outcomes of this strategy.
A previous randomized controlled trial comparing initial cholecystectomy with intraoperative
 cholangiogram (IOC) versus common bile duct (CBD) assessment and subsequent cholecystectomy
 for patients admitted in the emergency room with an acute gallstone-related condition and
 with an intermediate risk of common bile duct stone was performed by the investigators. This
 study had been registered on Clinicaltrials.gov as well and had shown that a strategy with
 initial cholecystectomy significantly decreased the length of hospital stay and the number of
 CBD investigations procedures.

 Initial cholecystectomy with IOC is now the standard management strategy for these patients
 in the investigators hospital. The goal of this study is to perform a prospective validation
 of this strategy and to analyze if the results obtained in the previously mentioned
 randomized controlled trial are confirmed on a larger patients cohort. This study will be
 observational, since the intervention (initial cholecystectomy) is not assigned by the
 investigators, but is already a standard treatment strategy at our institution.
Inclusion Criteria:

 -  Admission through emergency department for an acute gallstone-related condition
 (cholecystitis, gallstone pancreatitis, ascending cholangitis, suspicion of gallstone
 migration, choledocholithiasis)

 Exclusion Criteria:

 -  Severe sepsis or septic shock

 -  contra-indication to surgery

 -  previous surgery interfering with common bile duct assessment procedures (roux-en-y
 gastric bypass, etc.)

 -  previous cholecystectomy