ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure: a random comparison to the standard (two-step) procedure.
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Authors
Jones, M.
Johnson, Matthew
Samourjian, E.
Schlauch, Karen A.
Ozobia, N.
Issue Date
2013-06-01
Type
Article
Language
Keywords
cholecystectomy , choledocholithiasis , endoscopic retrograde cholangiopancreatography (ERCP) , GI endoscopy , one-step , two-step
Alternative Title
Abstract
Background�"Current treatment of complicated calculous biliary disease typically involves a two-step procedure consisting of preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Alternatively, laparoscopic cholecystectomy with intraoperative cholangiogram (IOC) and intraoperative common bile duct exploration or ERCP at a later date may be performed. This study compared the benefits of the traditional twostep procedure to the novel one-step procedure for the management of calculous biliary disease. Methods�"A retrospective review of 20 patients was conducted comparing one-step to two-step procedures for the management of choledocholithiasis. We define the one-step procedure to be a laparoscopic cholecystectomy with IOC to confirm the presence or absence of stones. Intraoperative ERCP with stone extraction was conducted if necessary as part of the one-step procedure. Results�"A statistically significant difference existed between hospital charges for one-step ($58,145.30, SD $17,963.09) and two-step ($78,895.53, SD $21,954.78) procedures (p = 0.033). Other parameters (length of stay, preoperative days) trended toward significance; however, statistical significance was not achieved. Conclusions�"There appears to be a significant cost reduction with implementation of the onestep treatment of calculous biliary disease. Further research with a larger study population is necessary to determine the additional benefits of this procedure and to help augment the surgical endoscopists' armamentarium
Description
Citation
Surg Endosc. 2013 Jun;27(6):1907-12. doi: 10.1007/s00464-012-2647-z. Epub 2012 Dec 13. Erratum in: Surg Endosc. 2013 Jun;27(6):1913. Slauch, Karen [corrected to Schlauch, Karen].
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In Copyright