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A practical cost-effective management strategy for gallstone pancreatitis
Lawrence E Tabone1, Molly Conlon, Emil Fernando
1Department of Surgery, Stritch School of Medicine, Loyola University of Chicago, 2160 South First Avenue, Maywood, IL 60153, USA; Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA.
American Journal of Surgery
|May 2, 2013
Summary
Early laparoscopic cholecystectomy with intraoperative cholangiogram is effective for gallstone pancreatitis. This strategy reduces hospital stay and costs compared to preoperative endoscopic retrograde cholangiopancreatography for common duct stones.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Biliary Tract Disease
Background:
- Gallstone pancreatitis (GP) management requires careful evaluation of common duct stones (CDSs).
- Surgeon strategies for CDS evaluation and treatment in mild to moderate GP vary.
- Optimizing patient outcomes and resource utilization is crucial.
Purpose of the Study:
- To evaluate surgeon strategies for CDS evaluation and treatment in mild to moderate GP.
- To compare outcomes of different management approaches for CDS in GP patients.
- To identify predictors for CDS presence.
Main Methods:
- Retrospective review of 80 patients with mild to moderate GP.
- Data analysis included laboratory values, imaging, intraoperative cholangiogram (IOC), and endoscopic retrograde cholangiopancreatography (ERCP).
- Comparison of two strategies: preoperative ERCP then LC, versus LC with IOC followed by selective postoperative ERCP.
Main Results:
- 33% of patients had CDS.
- Elevated total bilirubin predicted CDS presence.
- Laparoscopic cholecystectomy (LC) with IOC resulted in shorter length of stay (LOS) and lower hospital charges compared to preoperative ERCP.
Conclusions:
- Admission and 24-hour total bilirubin levels can predict CDS risk.
- Early LC with IOC is a cost-effective and efficient strategy for uncomplicated GP.
- This approach reduces LOS and hospital charges compared to preoperative ERCP.
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