May-Miller P, 1, Darbyshire A. 1, Hirri F. 1, Toh S. 1, Knight B. 1, Carter 1, Van Boxel G. 1, Pucher P. 1, Walters A.M. 1, Sutaria R. 1, Graetz K.1, Mercer S. 1
1Queen Alexandra Hospital, Portsmouth, United Kingdom
Background/Aims: Despite the evidence of the clinical and financial benefits of urgent cholecystectomy, and national guidelines for acute presentations of gallstone disease to be managed in index admission, there is variable uptake across the UK. There remains concern over the perceived risks of urgent cholecystectomy and, in some centres, difficulty in facilitating an increased volume through existing urgent or emergency channels.In 2014 in our unit, we implemented a specialist upper GI surgeon-led emergency service for all patients admitted with gallstone related pathologies in response to the NELA organisational audit. We present 5 years of data resulting from this service model.
Methods: This is a high volume single-centre observational cohort study. Data were collected prospectively from 1/1/2016-31/12/2020 and included 4870 cholecystectomies. Patient demographics, admission details, length of stay, duration of surgery and complications were analysed.
Results: 1793 (36.8%) were performed as urgent cases and the remaining 3077 (63.2%) as elective. All cases were started laparoscopically with 25 cases (0.51%) requiring conversion to open; 14 urgent and 11 elective (0.78% and 0.36% respectively). The reasons for conversion were for adhesions (n=5), CBD stone retrieval (n=4), to manage a perforated gallbladder (n=3), bleeding (n=1), and for CBD injury (n=1).Complications in the two groups were comparable. Bile leak occurred in 0.9% of both urgent and elective cases. There was 1 CBD injury (0.056%) in the urgent group and 0 in the elective. Subtotal cholecystectomy was performed in 1.8% of urgent and 0.78% of elective cases.
Conclusion: Urgent laparoscopic cholecystectomy is safe and feasible in most patients with acute gallbladder disease. Our data show that under a specialist team, rates of complication or conversion are low. The timing of surgery related to admission also has no significant effect on the rate of complications.
Keywords: Cholecystectomy, Biliary, Emergency, Urgent