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Introduction: Laparoscopic common bile duct exploration (LCBDE-LC) or ERCP plus laparoscopic cholecystectomy (ERCP-LC) represent minimally invasive choledocholithiasis treatments. We hypothesized that LCBDE-LC has a shorter length of stay (LOS) and lower charges than ERCP-LC.
Methods: Charts were reviewed for all LCBDE-LC or ERCP-LC for choledocholithiasis from 2007 to 2017. Exclusions included cholangitis, concomitant procedures, or history of Roux-en-Y or biliary surgery. Groups were determined via intention-to-treat with LCBDE-LC or ERCP-LC.
Results: 281 subjects were identified; 157 met inclusion criteria. 89 (56%) were in the LCBDE-LC group. There were no differences in age, sex, or ASA. LOS was shorter for LCBDE-LC (3.1 vs 4.4 days, p < 0.01) although total anesthesia time was longer (292 vs 262 min, p = 0.01). There was no difference in total charges ($44,412 vs $51,353, p = 0.08). Thirty (33%) LCBDE-LC were aborted due to challenges passing the dilator or scope (33%) or clearing stones (30%). Two ERCP-LC cases required post-procedure LCBDE.
Conclusion: LCBDE-LC resulted in shorter LOS but had a high failure rate. Further research is needed to predict which cases suit each modality.
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| http://dx.doi.org/10.1016/j.amjsurg.2019.03.006 | DOI Listing |
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