title: ERCP and laparoscopic cholecystectomy in a combined (one-step) procedure: a random comparison to the standard (two-step) procedure.
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.
authors.affiliation: Department of Surgery, University of Nevada School of Medicine, 2040 W Charleston Blvd Suite 301, Las Vegas, NV 89102, USA. msjones@medicine.nevada.edu
authors.forename: Maris
authors.initials: M
authors.lastname: Jones
authors.forename: Matthew
authors.initials: M
authors.lastname: Johnson
authors.forename: Edward
authors.initials: E
authors.lastname: Samourjian
authors.forename: Karen
authors.initials: K
authors.lastname: Schlauch
authors.forename: Karen
authors.initials: K
authors.lastname: Slauch
authors.forename: Nathan
authors.initials: N
authors.lastname: Ozobia
mesh_terms: D000293:Adolescent; D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D042883:Choledocholithiasis / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D056888:Patient Positioning; D012189:Retrospective Studies; D055815:Young Adult