Aldo Garbarini1, Dario Reggio2, Simone Arolfo1, Marco Bruno1, Roberto Passera1, Giorgia Catalano2, Claudio Barletti3, Mauro Salizzoni2, Mario Morino1, Luca Petruzzelli4, Alberto Arezzo5. 1. General Surgery 1U, Department of Surgical Sciences, University of Torino, Torino, Italy. 2. General Surgery 2U, Department of Surgical Sciences, University of Torino, Torino, Italy. 3. Department of Paediatric Gastroenterology, Città della Salute e della Scienza University Hospital, Torino, Italy. 4. Department of Emergency Surgery, Città della Salute e della Scienza University Hospital, Torino, Italy. 5. General Surgery 1U, Department of Surgical Sciences, University of Torino, Torino, Italy. alberto.arezzo@mac.com.
Abstract
BACKGROUND: Evidence from controlled trials and meta-analyses suggests that laparoendoscopic rendezvous (LERV) is preferable to sequential treatment in the management of common bile duct stones. MATERIALS AND METHODS: With this retrospective analysis of a prospective database that included consecutive patients treated for cholecystocholedocholithiasis at our institution between January 2007 and July 2015, we compared LERV with sequential treatment. The primary endpoint was global cost, defined as the cost/patient/hospital stay, and the secondary end points were efficacy and morbidity. Fisher's exact test or Mann-Whitney test was used. RESULTS: Of a total of 249 consecutive patients, 143 underwent LERV (group A) and 106 a two-stage procedure (group B). Based on an average cost of €613 for 1 day of hospital stay in the General Surgery Department, the overall median cost of treatment was €6403 for group A and €8194 for group B (p < 0.001). Operative time was significantly shorter (p < 0.001), and length of hospital stay was significantly longer for group B (p < 0.001). No mortality in either group was observed. The postoperative complications rate was significantly higher in group B than in group A (24.5 vs. 10.5%; p = 0.003). No significant difference in the postoperative pancreatitis rate or the number of patients with increased serum amylase at 24 h was observed in either group. CONCLUSION: Our study suggests that LERV is preferable to sequential treatment not only in terms of less morbidity, but also of lower costs accrued by a shorter hospital stay. However, the longer operative time raises multiple organizational issues in the coordination of surgery and endoscopy services.
BACKGROUND: Evidence from controlled trials and meta-analyses suggests that laparoendoscopic rendezvous (LERV) is preferable to sequential treatment in the management of common bile duct stones. MATERIALS AND METHODS: With this retrospective analysis of a prospective database that included consecutive patients treated for cholecystocholedocholithiasis at our institution between January 2007 and July 2015, we compared LERV with sequential treatment. The primary endpoint was global cost, defined as the cost/patient/hospital stay, and the secondary end points were efficacy and morbidity. Fisher's exact test or Mann-Whitney test was used. RESULTS: Of a total of 249 consecutive patients, 143 underwent LERV (group A) and 106 a two-stage procedure (group B). Based on an average cost of €613 for 1 day of hospital stay in the General Surgery Department, the overall median cost of treatment was €6403 for group A and €8194 for group B (p < 0.001). Operative time was significantly shorter (p < 0.001), and length of hospital stay was significantly longer for group B (p < 0.001). No mortality in either group was observed. The postoperative complications rate was significantly higher in group B than in group A (24.5 vs. 10.5%; p = 0.003). No significant difference in the postoperative pancreatitis rate or the number of patients with increased serum amylase at 24 h was observed in either group. CONCLUSION: Our study suggests that LERV is preferable to sequential treatment not only in terms of less morbidity, but also of lower costs accrued by a shorter hospital stay. However, the longer operative time raises multiple organizational issues in the coordination of surgery and endoscopy services.
Entities:
Keywords:
Common bile duct stones; ERCP; Laparoscopic cholecystectomy; Rendezvous technique
Authors: G Saccomani; V Durante; M R Magnolia; L Ghezzo; R Lombezzi; L Esercizio; M Stella; A Arezzo Journal: Surg Endosc Date: 2005-05-03 Impact factor: 4.584
Authors: A Cuschieri; E Lezoche; M Morino; E Croce; A Lacy; J Toouli; A Faggioni; V M Ribeiro; J Jakimowicz; J Visa; G B Hanna Journal: Surg Endosc Date: 1999-10 Impact factor: 4.584
Authors: S Vaccari; M Minghetti; A Lauro; M I Bellini; A Ussia; S Khouzam; I R Marino; M Cervellera; V D'Andrea; V Tonini Journal: Dig Dis Sci Date: 2022-03-22 Impact factor: 3.199