A general surgeon’s armamentarium is broad by definition, encompassing a range of skills and knowledge to treat benign biliary disease, among many others. Surgeons must be experts in providing optimal outcomes for this group of common surgical diseases such as biliary colic, acute cholecystitis, choledocholithiasis, cholangitis, biliary pancreatitis, and acalculous cholecystitis.
Despite their prevalence of benign biliary diseases in both elective and acute settings, there is conflicting evidence regarding their management, which complicates treatment decisions.
In this morning’s “Great Debates in Benign Biliary Disease,” the first of the four debate Panel Sessions at Clinical Congress 2025, a group of experts will discuss the sometimes complicated decision-making and significant variability in practice in this group of ubiquitous conditions.
“There are many controversies in the management of benign biliary disease, and there is often more than one way to address a problem such as common bile duct stone,” said session moderator Taylor S. Riall, MD, PhD, FACS, from The University of Arizona College of Medicine in Tucson. “Often, the approach varies based on the local expertise of both surgeons and gastroenterologist. In addition, there is emerging technology that has changed the potential management of these common problems.”
This 90-minute session will be in the format of three separate, but related debates, with speakers debating controversial topics in benign biliary disease.
Robotic versus Laparoscopic Approach for Cholecystectomy
Widespread adoption of the surgical robot for multiple surgical procedures has brought into question the pros and cons of this approach for cholecystectomy, weighed against the current “gold standard” laparoscopic approach.
This debate will look at cost, operative time, visualization, and allocation of the precious resource of the robots, which is a critical decision at some institutions that are beginning to offer increased access to multiple specialties.
Endoscopic Retrograde Cholangiopancreatography (ERCP) versus Laparoscopic Common Bile Duct (CBD) Exploration for Choledocholithiasis
For suspected stones in the CBD, there are multiple options for clearing the deposits. Two experts will debate the pros and cons of an endoscopic approach with ERCP against the surgical, minimally invasive exploration of the bile duct that will explore outcomes, patient recovery, experience, and more.
Open versus Laparoscopic Bail Out Procedures for the Difficult Gallbladder
During a planned procedure, surgeons are often faced with difficult gallbladders due to adhesions, unusual or challenging anatomy, or other intraoperative complications. Safe bailout procedures are necessary to minimize life-changing complications, such as injury to the bile duct—but is best bail out approach?
In this debate, experts will discuss whether converting to open surgery, with its improved visualization but potential added challenges related to patient recovery and diminished clinician experience with the approach, or maintaining the already engaged laparoscopic approach preferable is preferable.
“Because these conditions are so core to a general surgeon’s practice, we are expecting this session will be an active debate, and one with significant time reserved for questions and perspectives from the audience,” Dr. Riall said.
Join the debate in Room W-185bc, 9:45–11:15 am.
