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Fifteen new bidesmosidic triterpenoid saponins (1-15) were isolated from a methanol extract of the leaves of Mimusops laurifolia. Their structures were established using one- and two-dimensional NMR spectroscopy and mass spectrometry and determined to be bidesmosides of protobassic acid (2-4, 11, 12, and 15) and of 16alpha-hydroxyprotobassic acid (1, 5-10, 13, and 14).

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Background Single‐stage approach with bile duct exploration is considered the most efficient and cost‐effective method of bile duct clearance. In Australia, apart from centres with subspecialty interests, notably in Brisbane, Queensland, a multi‐stage approach with endoscopic retrograde cholangiopancreatography (ERCP) is used more frequently. We aim to evaluate the impact of single stage laparoscopic trans‐cystic exploration (LTCE) versus multi‐stage approach for choledocholithiasis. Methods This was a retrospective cohort study. Medicare Benefits Schedule codings were used to identify patients who had the following procedures between December 2011 and December 2019: laparoscopic cholecystectomy (LC) and ERCP, LC and LTCE, LC and LTCE and ERCP. Primary outcomes were number of hospital procedures, admissions and additive length of stay (aLOS), the cumulative hospital stay from admission to discharge. Results Of 607 patients, 204 (34%) patients received a single‐stage LTCE, while 403 (66%) patients had a multi‐stage approach. In the LTCE group, 82% (168) patients and 93% (190) patients had one procedure and one admission respectively for stone clearance (P = 0.001). The median aLOS was 4 days for LTCE versus 7 days for multi‐stage approach (P = 0.001; 95% CI for difference − 3 to −2). In the multi‐stage group, 16% (65) patients had three or more procedures and 49% (199) patients required two or more hospital admissions to achieve stone clearance. Conclusion LTCE for stone clearance can be successfully accomplished with reductions in hospital admissions, number of procedures and length of stay. This has further economic and health resource implications.