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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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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cited_by cdi_FETCH-LOGICAL-c323t-82cdbb3131ac063afe2fc6510aff7e140d52533ff0bab5c66e338f983e5da8be3
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container_title The American journal of surgery
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creator Morton, Alexander
Cralley, Alexis
Brooke-Sanchez, Maggie
Pieracci, Fredric M.
description 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 
doi_str_mv 10.1016/j.amjsurg.2022.03.026
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Length of stay for LCBDE vs ERCP was 2.5 (1–3) vs 5 (3–5) days (p &lt; 0.01). Charges during initial hospitalization was $35858 ($26587-$49570) vs $48662 ($36018-$57106) (p = 0.05). LCBDE by acute care surgeons at the time of LC was associated with lower charges, reduced hospital length of stay, low rates of post-operative complications, and no readmissions. •At a safety net hospital LCBDE at the time of LC is associated with reduced length of stay and charges compared to ERCP.•LCBDE at the time of laparoscopic cholecystectomy is a safe and effective procedure.•Common bile duct exploration at the time of LC is within the skill set of ACS and General Surgeons.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2022.03.026</identifier><identifier>PMID: 35351289</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>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</subject><ispartof>The American journal of surgery, 2022-07, Vol.224 (1), p.116-119</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. 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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
title Laparoscopic common bile duct exploration by acute care surgeons saves time and money compared to ERCP
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