title: Laparoscopic common bile duct exploration in children is associated with decreased cost and length of stay: results of a two-center analysis.
abstract: OBJECTIVE
  Our aim was to compare outcomes of children undergoing laparoscopic cholecystectomy with laparoscopic common bile duct exploration (LC+CBDE) to those undergoing laparoscopic cholecystectomy with adjunctive endoscopic retrograde cholangiopancreatography (LC+ERCP).
  
  
  METHODS
  We performed a two-center retrospective chart review of all children (<18 years) undergoing LC+CBDE or LC+ERCP between January 2000 and July 2011. Wilcoxon test was performed on continuous variables and logistic regression modeling on categorical data. A P value < 0.05 was considered significant. Outcomes with a P value < 0.2 were selected for multivariable analysis.
  
  
  RESULTS
  Forty-two patients were identified. Twenty-four (57%) underwent LC+ERCP, and eighteen (43%) underwent LC+CBDE. Demographic and clinical factors were well matched between groups. Total operative time was similar between groups (157 min vs. 152 min, P = .26). LC+CBDE patients had zero major complications and five minor complications (retained stone: 3, pancreatitis: 1, late recurrence: 1). LC+ERCP patients experienced two major complications (duodenal perforation: 1, bleeding requiring transfusion: 1), and four minor complications (pancreatitis: 2, retained stone: 2, P = .57). Median length of stay was significantly longer (15.7 days vs. 6.6 days, P = .02), and median hospital cost was significantly higher ($18,132 vs. $12,735, P < .01) in the LC+ERCP group. Multivariable analysis revealed that cost was significantly lower in patients undergoing LC+CBDE (P = .05, OR= 0.71; 95% CI: 0.51-0.97).
  
  
  CONCLUSIONS
  LC+CBDE at the time of cholecystectomy is associated with decreased length of stay, decreased cost, and has similar or improved morbidity compared to LC+ERCP.
authors: Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors: Scott S
authors: SS
authors: Short
authors: Philip K
authors: PK
authors: Frykman
authors: Nam
authors: N
authors: Nguyen
authors: Quin
authors: Q
authors: Liu
authors: Dror
authors: D
authors: Berel
authors: Kasper S
authors: KS
authors: Wang
mesh_terms: D000293:Adolescent; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000706:statistics & numerical data; D042883:Choledocholithiasis / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D016015:Logistic Models; D015141:Los Angeles; D008297:Male; D015999:Multivariate Analysis; D061646:Operative Time; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome