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Cost analysis of laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis

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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.

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References

  1. Menezes N, Marso LP, Debeaux AC, Muir IM, Auld CD (2000) Prospective analysis of a scoring system to predict choledocholithiasis. Br J Surg 87:1176–1181

    Article  CAS  PubMed  Google Scholar 

  2. Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 239:28–33

    Article  PubMed  PubMed Central  Google Scholar 

  3. NIH Consensus Conference (1993) Gallstones and laparoscopic cholecystectomy. JAMA 269:1018–1024

    Article  Google Scholar 

  4. Perniceni T, Slim K (2001) Quelles sont les indications vlidées de la coelioscopie en chirurgie digestive. Gastroenterol Clin Biol 25:B57–B70

    CAS  PubMed  Google Scholar 

  5. Martin DJ, Vernon DR, Toouli J (2013) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 9:CD003327.

    Google Scholar 

  6. Cuschieri A, Lezoche E, Morino M, Croce E, Lacy A, Toouli J, Faggioni A, Ribeiro M, Jakimowicz J, Visa J, Hanna GB (1999) E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 13:952–957

    Article  CAS  PubMed  Google Scholar 

  7. Carr-Locke DL et al (2002) Therapeutic role of ERCP in the management of suspected common bile duct stones. Gastrointest Endosc 56:170–174

    Article  Google Scholar 

  8. Cavina E, Franceschi M, Sidoti F, Goletti O, Buccianti P, Chiarugi M (1998) Laparoendoscopic, “rendezvous”: a new technique in the choledocholithiasis treatment. Hepatogastroenterology 45:1430–1435

    CAS  PubMed  Google Scholar 

  9. Lella F, Bagnolo F, Rebuffat C, Scalambra M, Bonassi U, Colombo E (2006) Use of laparoscopic-endoscopic approach, the so-called rendezvous technique in cholecystocholedocholithiasys. A valid method in cases with patient-related risk factor for post-ERCP pancreatitis. Surg Endosc 20:419–423

    Article  CAS  PubMed  Google Scholar 

  10. Morino M, Baracchi F, Miglietta C, Furlan N, Ragona R, Garbarini A (2006) Preoperative endoscopic sphincterotomy versus laparoendoscopic rendezvous in patients with gallbladder and bile duct stones. Ann Surg 244:889–896

    Article  PubMed  PubMed Central  Google Scholar 

  11. Rabago LR, Vicente C, Soler F, Delgado M, Moral I, Guerra I, Castro JL, Quintanilla E, Romeo J, Llorente R, Vazquez Echarri J, Martinez-Veiga JL, Gea F (2006) Two-stage treatment with preoperative endoscopic retrograde cholangiopancreatography (ERCP) compared with single-stage treatment with intraoperative ERCP for patients with symptomatic cholelithiasis with possible choledocholithiasis. Endoscopy 38:779–786

    Article  CAS  PubMed  Google Scholar 

  12. Tsovaras G, Baloyiannis I, Zachari E, Symeonidis D, Zacharoulis D, Kapsoritakis A, Paroutoglou G, Potamianos S (2012) Laparoendoscopic rendezvous versus preoperative ERCP and laparoendoscopic cholecystectomy for the management of cholecystocholedicholithiasis: interim analysis of a controlled randomized trial. Ann Surg 255:435–439

    Article  Google Scholar 

  13. Arezzo A, Vettoretto N, Famiglietti F, Moja L, Morino M (2013) Laparoendoscopic rendezvous reduces perioperative morbidity and risk of pancreatitis. Surg Endosc 27:1055–1060

    Article  PubMed  Google Scholar 

  14. La Greca G, Barbagallo F, Sofia M, Latteri S, Rusello D (2010) Simultaneous laparoendoscopic rendezvous for the treatment of cholecystocholedocholithiasis. Surg Endosc 24:769–780

    Article  Google Scholar 

  15. De Palma GD, Angrisani L, Lorenzo M, Di Matteo E, Catanzano C, Persico G, Tesauro B (1996) Laparoscopic cholecystectomy (LC), intraoperative endoscopic sphincterotomy (ES), and common bile duct stones (CBDS) extraction for management of patient with cholecystocholedocholithiasis. Surg Endosc 10:649–652

    Article  PubMed  Google Scholar 

  16. Moroni J, Haurie JP, Judchak I, Fuster S (1999) Single-stage laparoscopic and endoscopic treatment for choledocholithiasis: a novel approach. J Laparoendosc Adv Surg Tech A 9:69–74

    Article  CAS  PubMed  Google Scholar 

  17. Tricarico A, Cione G, Sozio M, Di Palo P, Bottino V, Tricarico T, Tartatglio A, Iazzetta I, Sessa E, Mosca S, De Nucci C, Falco P (2002) Endolaparoscopic rendezvous treatment: a satisfying therapeutic choice for cholecystocholedocolithiasis. Surg Endosc 16:711–713

    Article  CAS  PubMed  Google Scholar 

  18. Sanjay P, Kulli C, Polignano FM, Tait IS (2010) Optimal surgical technique, use of intra-operative cholangiography, and management of acute gallbladder disease: the results of a nation-widde survey in the UK and Ireland. Ann R Coll Surg Engl 92:302–306

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Clayton E, Connor S, Alexakis N, Leandros E (2006) Metaanalysis of endoscopy and surgery versus surgery alone for common bile duct stones with the gallbladder in situ. Br J Surg 93:1185–1191

    Article  CAS  PubMed  Google Scholar 

  20. Hunter JG (1992) Laparoscopic transcystic common bile duct exploration. Am J Surg 163:53–65

    Article  CAS  PubMed  Google Scholar 

  21. Saccomani G, Durante V, Magnolia MR, Ghezzo L, Lombezzi R, Esercizio L, Stella M, Arezzo A (2005) Combined endoscopic treatment for cholelithiasis associated with choledocholithiasis. Surg Endosc 19:910–914

    Article  CAS  PubMed  Google Scholar 

  22. R Foundation for Statistical Computing, Vienna-A. http://www.R-project.org

  23. Ding X, Zhang F, Wang Y (2015) Risk factors for post-ERCP pancreatitis: a systematic review and meta-analysis. Surgeon 13:218–229

    Article  PubMed  Google Scholar 

  24. La Greca G, Barbagallo F, Di Blasi M, Chisari A, Lombardo R, Bonaccorso R, Latteri S, Di Stefano A, Russello D (2008) Laparoendoscopic, “rendezvous” to treat cholecystocholedocolithiasis: effective, safe and simplifies the endoscopist’s work. World J Gastroenterol 14:2844–2850

    Article  PubMed  PubMed Central  Google Scholar 

  25. Williams GL, Vellacott KD (2002) Selective operative cholangiography and perioperative endoscopic retrograde cholangiopancreatography (ERCP) during laparoscopic cholecystectomy: a viable option for choledocholithiasis. Surg Endosc 16:465–467

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. General Surgery 1U, Department of Surgical Sciences, University of Torino, Torino, Italy

    Aldo Garbarini, Simone Arolfo, Marco Bruno, Roberto Passera, Mario Morino & Alberto Arezzo

  2. General Surgery 2U, Department of Surgical Sciences, University of Torino, Torino, Italy

    Dario Reggio, Giorgia Catalano & Mauro Salizzoni

  3. Department of Paediatric Gastroenterology, Città della Salute e della Scienza University Hospital, Torino, Italy

    Claudio Barletti

  4. Department of Emergency Surgery, Città della Salute e della Scienza University Hospital, Torino, Italy

    Luca Petruzzelli

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  1. Aldo Garbarini
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Correspondence to Alberto Arezzo.

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Disclosures

Aldo Garbarini, Dario Reggio, Simone Arolfo, Marco Bruno, Roberto Passera, Giorgia Catalano, Claudio Barletti, Mauro Salizzoni, Mario Morino, Luca Petruzzelli, and Alberto Arezzo have no conflicts of interest or financial ties to disclose.

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Garbarini, A., Reggio, D., Arolfo, S. et al. Cost analysis of laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis. Surg Endosc 31, 3291–3296 (2017). https://doi.org/10.1007/s00464-016-5361-4

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  • DOI: https://doi.org/10.1007/s00464-016-5361-4

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