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“Ultra-rapid” sequential treatment in cholecystocholedocholithiasis: alternative same-day approach to laparoendoscopic rendezvous

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Abstract

There is still no consensus about timing of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography in the treatment of cholecystocholedocholithiasis. The aim of our retrospective study is to analyze the optimal timing of surgical treatment in patients presenting concurrent choledocholithiasis, choosing to perform a sequential endoscopic plus surgical approach, introducing a same-day two-stage alternative. All cases of cholecystocholedocholithiasis occurred between January 2007 and December 2014 in “Gradenigo” Hospital (Turin—Italy) were reviewed. Patients were divided into three groups, based on the timing of cholecystectomy after endoscopic retrograde cholangiopancreatography, and compared. Out of 2233 cholecystectomies performed in the mentioned time interval, have been identified 93 patients that fulfill the selection criteria. 36 patients were treated with a same-day approach, while 29 within first 72 h and 28 with delayed surgery. The overall length of stay was significantly lower in patients that were treated with a same-day approach (4.7 days), compared with other groups (p = 0.001), while no significant differences were found in terms of length of surgical intervention, intraoperative complications and conversions to open procedure, postoperative stay, morbidity and mortality. Patients treated with delayed surgery had a 18 % recurrency rate of biliary events, with an odds ratio of 14.13 (p = 0.018). Same-day two-stage approach should be performed in suitable patients at the index admission, reducing overall risks, improving the patients’ quality-of-life, preventing recurrency, leading to a significant cost abatement; furthermore, this approach allows same outcomes of laparoendoscopic rendezvous, avoiding technical and organizational troubles.

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Authors and Affiliations

  1. Department of General Surgery, “Gradenigo” Hospital, Turin, Italy

    Dario Borreca, Alberto Bona, Maria Paola Bellomo, Andrea Borasi & Paolo De Paolis

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  1. Dario Borreca
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  2. Alberto Bona
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  3. Maria Paola Bellomo
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  4. Andrea Borasi
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  5. Paolo De Paolis
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Correspondence to Dario Borreca.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Borreca, D., Bona, A., Bellomo, M.P. et al. “Ultra-rapid” sequential treatment in cholecystocholedocholithiasis: alternative same-day approach to laparoendoscopic rendezvous. Updates Surg 67, 449–454 (2015). https://doi.org/10.1007/s13304-015-0339-7

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  • DOI: https://doi.org/10.1007/s13304-015-0339-7

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