Su1537 TREATMENT OF CHOLELITHIASIS WITH CHOLEDOCHOLITHIASIS THROUGH THE ASSOCIATION OF LAPAROSCOPIC AND ENDOSCOPIC ACCESS, IN ONE-TIME AND OUTPATIENT BASIS, WITH COST ANALYSIS

Abstract

The advantages of the treatment of choledocholithiasis and cholelithiasis in a single surgical time have been well established, but the types of access used and their combinations, the assistance processes and the assessment of cost effectiveness are still being studied. To evaluate the profile of patients with choledocholithiasis plus cholelithiasis treated by combined laparoscopic and endoscopic access in a single time on an outpatient basis and to determine the treatment costs. A retrospective study was conducted on patients with choledocholithiasis plus cholelithiasis treated by combined laparoscopic cholecystectomy and endoscopic choledocholithotomy from January 2015 to January 2019. The patients were divided into two groups: AR (n=42) – ambulatory regimen and HR (n=28) – hospitalization regimen – which were compared in terms of demographic, clinical and treatment variables and their results, as well as in terms of costs. The mean age of the AR group was lower than that of the HR group (43.52 x 53.46 years, p=0.03) and the physical status of the AR patients was better when assessed according to the American Society of Anesthesiologists (ASA) (p=0.01). There was no difference between groups regarding the risk of choledocholithiasis (p=0.99). For the AR group, the length of stay was shorter: 11.29 hours (6.15) x 65.21 hours (71.72) (p=0.02), as was the incidence of postoperative complications assessed by applying the Clavien-Dindo classification: 3.0 (7.1%) X 11 (39.2%) (p<0.01). The total mean costs were higher for the HR group ($2,489.93) than the AR group ($1,650.98) (p=0.02) (Figures 1 and 2). The combination of laparoscopic cholecystectomy and endoscopic choledocholithotomy, in a single time, on an outpatient basis, is safe and feasible for patients in good health, has a lower cost and may support the reorientation of hepatobiliary surgeon training with the integrated use of technological resources and the adoption of care protocols aimed at better clinical management of the choledocholithiasis approach.