Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 14;13(2):460.
doi: 10.3390/jcm13020460.

The Safety and Cost Analysis of Outpatient Laparoendoscopy in the Treatment of Cholecystocholedocholithiasis: A Retrospective Study

José Sebastião Dos Santos  1 , Rafael Kemp  1 , Alicia Guadalupe Mendoza Orquera  2 , Alberto Facury Gaspar  2   3 , Jorge Resende Lopes Júnior  3 , Lucas Tobias Almeida Queiroz  2 , Víctor Antônio Peres Alves Ferreira Avezum  2 , José Celso Ardengh  3   4   5 , Ajith Kumar Sankarankutty  1 , Leonardo Santos Lima  2
Affiliations

The Safety and Cost Analysis of Outpatient Laparoendoscopy in the Treatment of Cholecystocholedocholithiasis: A Retrospective Study

José Sebastião Dos Santos et al. J Clin Med. .

Abstract

Introduction: The advantages of single-stage treatment of cholecystocholedocholithiasis are well established, but the conditions for carrying out treatment on an outpatient basis require a review of concepts and practices of medical corporations.

Objective: To evaluate the practice of treating cholecystocholedocholithiasis by laparoendoscopy on an outpatient basis with cost analysis.

Method: A retrospective study was conducted on patients with cholecystocholedocholithiasis treated by combined laparoscopic cholecystectomy and endoscopic choledocholithotomy from January 2015 to January 2019. After collecting data from physical and digital medical records, the patients were divided into two groups-AR (n = 42)-ambulatory regimen and HR (n = 28)-hospitalization regimen-which were compared in terms of demographic, clinical and treatment variables and their results, as well as in terms of costs.

Results: The mean age of the AR group was lower than that of the HR group and the physical status of the AR patients was better when assessed according to the American Society of Anesthesiologists (ASA) (p = 0.01). There was no difference between groups regarding the risk of choledocholithiasis (p = 0.99). For the AR group, the length of stay was shorter: 11.29 h × 65.21 h (p = 0.02), as was the incidence of postoperative complications assessed by applying the Clavien-Dindo classification: 3 (7.1%) × 11 (39.2%) (p < 0.01). The total mean costs were higher for the HR group (USD 2489.93) than the AR group (USD 1650.98) (p = 0.02).

Conclusion: Outpatient treatment of cholecystocholedocholithiasis by laparoendoscopy is safe and viable for most cases, has a lower cost and can support the reorientation of training and practice of hepatobiliary surgeons.

Keywords: cholecystocholedocholithiasis; choledocholithiasis; cost analysis; endoscopic sphincterotomy; intraoperative endoscopy; laparoendoscopy; laparoscopic; outpatient surgery.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram for patient selection.
Figure 2
Figure 2
Total cost of the treatment of patients with cholelithiasis and choledocholithiasis performed by laparoendoscopy (LE) on an ambulatory regimen (AR) and hospitalization regimen (HR), with or without complications, from January 2015 to January 2019. Legend: * and circle (outliers).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Ricci C., Pagano N., Taffurelli G., Pacilio C.A., Migliori M., Bazzoli F., Casadei R., Minni F. Comparison of efficacy and safety of 4 combinations of laparoscopic and intraoperative techniques for management of gallstone disease with biliary duct calculi: A Systematic Review and Network Meta-analysis. JAMA Surg. 2018;153:e181167. doi: 10.1001/jamasurg.2018.1167. - DOI - PMC - PubMed
    1. Bove A., Panaccio P., di Renzo R., Palone G., Ricciardiello M., Ciuffreda S., Bongarzoni G. How to choose the most appropriate technique for the single-stage treatment of cholecysto-choledocolithiasis? Gastroenterol. Rep. 2019;7:258–262. doi: 10.1093/gastro/goz022. - DOI - PMC - PubMed
    1. Lyu Y., Cheng Y., Li T., Cheng B., Jin X. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: A meta-analysis. Surg. Endosc. 2019;33:3275–3286. doi: 10.1007/s00464-018-06613-w. - DOI - PubMed
    1. Wang B., Guo Z., Liu Z., Wang Y., Si Y., Jin M. Preoperative versus intraoperative endoscopic sphincterotomy in patients with gallbladder and suspected common bile duct stones: System review and meta-analysis. Surg. Endosc. 2013;27:2454–2465. doi: 10.1007/s00464-012-2757-7. - DOI - PubMed
    1. Manes G., Paspatis G., Aabakken L., Ardeloni A., Arvanitakis M., Ah-Soune P., Barthet M., Domagk D., Domonceau J., Gigot J., et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy. 2019;51:472–491. doi: 10.1055/a-0862-0346. - DOI - PubMed