Same-day combined endoscopic retrograde cholangiopancreatography and cholecystectomy

Abstract

Therapeutic study, level IV. Economic study, level III.

Single-session laparoscopic cholecystectomy and ERCP: a valid option for the management of choledocholithiasis

“…The identification of single-session patients preoperatively in our series permitted greater ease of operative scheduling and allowed the procedures to be coordinated with both groups of providers as well as operating room personnel. Our observations, as well as those of other investigators, 20,21 have suggested that 1 of the predominant limiting factors in the acceptance of single-session ERCP and LC is the difficulty of coordination between providers and availability of operating room time. 22 At our center, all ERCPs are routinely performed in 2 of the 24 operating rooms, all in immediate proximity.…”

“…Another essential component of this practice is to obtain consent for ERCP before cholecystectomy in all patients suspected of having CBD stones or undergoing IOC. Another recent single-center retrospective study performed by Wild et al 21 compared cholecystectomy and ERCP performed separately with cholecystectomy and ERCP on the same day and demonstrates the safety and efficacy as well as cost benefit for the latter approach. In their study, ERCP was conducted in an endoscopy suite, and the patient was transported to the operating room for subsequent cholecystectomy.…”

Randomized clinical trial of intraoperative endoscopic retrograde cholangiopancreatography versus laparoscopic bile duct exploration in patients with choledocholithiasis

“…The aim of this study was to compare the two single‐stage approaches using laparoscopy and endoscopy in patients undergoing emergency laparoscopic cholecystectomy with choledocholithiasis, in line with recommendations from a recent Cochrane review that further randomized clinical trials are needed to validate existing data on the topic. Single‐stage approaches may shorten length of hospital stay and be more efficacious. It was hypothesized that intraoperative ERCP would be no different to LBDE in terms of rates of bile duct clearance or retained stones in patients undergoing laparoscopic cholecystectomy.…”

Prolonged length of stay in delayed cholecystectomy is not due to intraoperative or postoperative contributors

“…Even for patients requiring ERCP, Wild et al showed that same-day ERCP and cholecystectomy is not only feasible, but minimizes cost. 15 In addition, for patients receiving only one pre-operative study, the majority (65.2%) experienced a delay to the OR and, on average, had a two-day increase in length of stay. This increase in total length of stay has many implications for our patients, an immigrant, working-class population with decreased access to healthcare services and a tendency to present late in the disease process.…”