Surgical Endoscopy

, Volume 27, Issue 6, pp 1907–1912

ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure: a random comparison to the standard (two-step) procedure

  • Maris Jones
  • Matthew Johnson
  • Edward Samourjian
  • Karen Slauch
  • Nathan Ozobia
Article

DOI: 10.1007/s00464-012-2647-z

Cite this article as:
Jones, M., Johnson, M., Samourjian, E. et al. Surg Endosc (2013) 27: 1907. doi:10.1007/s00464-012-2647-z

Abstract

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 two-step 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 one-step 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.

Keywords

CholecystectomyCholedocholithiasisEndoscopic retrograde cholangiopancreatography (ERCP)GI endoscopyOne-stepTwo-step

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Maris Jones
    • 1
  • Matthew Johnson
    • 1
  • Edward Samourjian
    • 1
  • Karen Slauch
    • 2
  • Nathan Ozobia
    • 1
  1. 1.Department of SurgeryUniversity of Nevada School of MedicineLas VegasUSA
  2. 2.Bioinformatics CenterUniversity of NevadaRenoUSA