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|Author||Schlauch, Karen A.|
|Date of Issue||6/1/2013|
|Identifier (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].|
|Description||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|
|Subject||endoscopic retrograde cholangiopancreatography (ERCP)
|Title||ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure: a random comparison to the standard (two-step) procedure.|