title: Cost analysis of laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy in the management of cholecystocholedocholithiasis.
abstract: Evidence from controlled trials and meta-analyses suggests that laparoendoscopic rendezvous (LERV) is preferable to sequential treatment in the management of common bile duct stones.
  
  
  
  With this retrospective analysis of a prospective database that included consecutive patients treated for cholecystocholedocholithiasis at our institution between January 2007 and July 2015, we compared LERV with sequential treatment. The primary endpoint was global cost, defined as the cost/patient/hospital stay, and the secondary end points were efficacy and morbidity. Fisher's exact test or Mann-Whitney test was used.
  
  
  
  Of a total of 249 consecutive patients, 143 underwent LERV (group A) and 106 a two-stage procedure (group B). Based on an average cost of €613 for 1 day of hospital stay in the General Surgery Department, the overall median cost of treatment was €6403 for group A and €8194 for group B (p < 0.001). Operative time was significantly shorter (p < 0.001), and length of hospital stay was significantly longer for group B (p < 0.001). No mortality in either group was observed. The postoperative complications rate was significantly higher in group B than in group A (24.5 vs. 10.5%; p = 0.003). No significant difference in the postoperative pancreatitis rate or the number of patients with increased serum amylase at 24 h was observed in either group.
  
  
  
  Our study suggests that LERV is preferable to sequential treatment not only in terms of less morbidity, but also of lower costs accrued by a shorter hospital stay. However, the longer operative time raises multiple organizational issues in the coordination of surgery and endoscopy services.
authors.affiliation: General Surgery 1U, Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Garbarini
authors.affiliation: General Surgery 2U, Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Reggio
authors.affiliation: General Surgery 1U, Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Arolfo
authors.affiliation: General Surgery 1U, Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bruno
authors.affiliation: General Surgery 1U, Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Passera
authors.affiliation: General Surgery 2U, Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Catalano
authors.affiliation: Department of Paediatric Gastroenterology, Città della Salute e della Scienza University Hospital, Torino, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Barletti
authors.affiliation: General Surgery 2U, Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
authors.affiliation: General Surgery 1U, Department of Surgical Sciences, University of Torino, Torino, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Morino
authors.affiliation: Department of Emergency Surgery, Città della Salute e della Scienza University Hospital, Torino, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Petruzzelli
authors.affiliation: General Surgery 1U, Department of Surgical Sciences, University of Torino, Torino, Italy. alberto.arezzo@mac.com.
authors.forename: Alberto
authors.identifier: 0000-0002-2110-4082
authors.initials: A
authors.lastname: Arezzo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000191:economics* / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000191:economics* / Q000401:mortality; D002764:Cholecystitis / Q000601:surgery; D042883:Choledocholithiasis / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D042882:Gallstones / Q000191:economics / Q000601:surgery*; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
keywords: Common bile duct stones; ERCP; Laparoscopic cholecystectomy; Rendezvous technique