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A More Cost-effective Approach Than Operative Duct Exploration?

Greg Van Stiegmann, MD; Nathan W. Pearlman, MD; John S. Goff, MD; John H. Sun, MD; Lawrence W. Norton, MD

Arch Surg. 1989;124(7):787-790.

Abstract
• Would economic benefit result from performing endoscopic cholangiography and removal of common bile duct stones prior to cholecystectomy in patients who are suspected preoperatively of having choledocholithiasis? In this study, 173 patients had cholecystectomy and 30 (17%) had common bile duct exploration. Records of these patients were reviewed as were those of 31 patients who had only endoscopic cholangiography and endoscopic stone removal. Cost estimates were based on local charges. Cholecystectomy with common bile duct exploration was $6730 more per patient than cholecystectomy alone. Endoscopic cholangiography and endoscopic stone removal was 87% successful in removing duct stones. Had endoscopic cholangiography and endoscopic stone removal been performed preoperatively in patients undergoing cholecystectomy who had suspected choledocholithiasis, 21 of 30 common bile duct explorations could theoretically have been eliminated. This would have saved $85 526 or $2851 per patient undergoing common bile duct exploration. Our analysis suggests that patients who require cholecystectomy and have suspected choledocholithiasis may be treated more cost-effectively by performing endoscopic cholangiography and endoscopic stone removal immediately prior to cholecystectomy than by cholecystectomy and operative common bile duct exploration.

(Arch Surg. 1989;124:787-790)

Author Affiliations
From the Departments of Surgery (Gastrointestinal/Tumor) (Drs Stiegmann, Pearlman, Sun, and Norton) and Medicine (Gastroenterology) (Dr Goff), University of Colorado and Denver Veterans Administration Hospitals.

Footnotes
Accepted for publication March 11, 1989.

Read before the 96th Annual Meeting of the Western Surgical Association, San Diego, Calif, November 14, 1988.

Reprint requests to University of Colorado Health Sciences Center, Box C-313, 4200 E Ninth Ave, Denver, CO 80262 (Dr Stiegmann).

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