Laparoscopic common bile duct exploration by acute care surgeons saves time and money compared to ERCP

A typical pathway for treatment of choledocholithiasis (CD) in emergency general surgery patients involves same admission laparoscopic cholecystectomy (LC) with either preoperative or postoperative endoscopic retrograde cholangiopancreatography (ERCP). The goal of this study was to describe our init...

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Bibliographic Details
Published in:The American journal of surgery 2022-07, Vol.224 (1), p.116-119
Main Authors: Morton, Alexander, Cralley, Alexis, Brooke-Sanchez, Maggie, Pieracci, Fredric M.
Format: Article
Language:English
Subjects:
Acute care surgery
Bile ducts
Bilirubin
Cholecystectomy
Choledocholithiasis
Complications
Confidence intervals
Costs
Endoscopic retrograde cholangiopancreatography
Hospitals
Laboratories
Laparoscopic common bile duct exploration
Laparoscopy
Length of stay
Patients
Postoperative
Safety-net hospital
Skills
Small intestine
Statistical analysis
Success
Surgeons
Surgery
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Summary:A typical pathway for treatment of choledocholithiasis (CD) in emergency general surgery patients involves same admission laparoscopic cholecystectomy (LC) with either preoperative or postoperative endoscopic retrograde cholangiopancreatography (ERCP). The goal of this study was to describe our initial experience at a safety net hospital with acute care surgeon-performed laparoscopic common bile duct exploration (LCBDE) when CD is confirmed at the time of LC. We hypothesized that this strategy would result in reduced length of stay, and lower charges compared to ERCP. This was a retrospective case control study over a 2 year period matching LCBDE to ERCP (1:3) among a cohort of patients with CD confirmed at first procedure. Data is reported as median (interquartile range). Statistical analysis used the Kruskal-Wallis and Chi-squared tests with 95% confidence interval. Demographics, preoperative WBC, and bilirubin were similar between the LCBDE (n = 14) and ERCP (n = 37) groups. Success rate for LCBDE was 11/14 (79%), and the remaining three subjects successfully underwent post-operative ERCP. Overall complication rate for the LCBDE group was 1/14 (7%) and the readmission rate was 0/14 (0%). Length of stay for LCBDE vs ERCP was 2.5 (1–3) vs 5 (3–5) days (p 
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2022.03.026