Acute laparoscopic cholecystectomy: preferred treatment for acute biliary disease

Early laparoscopic cholecystectomy has been shown to be the treatment of choice for acute presentations of gallstone disease. However, currently this practice is not common in many centres. The aim of the study was to evaluate surgical management of patients presenting with acute symptomatic gallstone disease to Middlemore Hospital in 2005.

A retrospective case review of acute presentations of symptomatic gallstone disease was carried out between 1 January and 31 December 2005.

Four hundred and two patients were included in the final analysis. Forty-six of these patients were unfit for surgery, 26 were solely admitted to the emergency department without being referred to a surgical team and 25 declined surgery. Therefore, 305 patients (76%) were eligible for surgery at index admission (IA). Two hundred and four (67%) received surgery during IA with a median time to surgery of 3 days. From the 198th patient who did not have acute surgery at IA, 112 had delayed surgery. When comparing those with surgery at IA with those who did not receive surgery at IA, median length of stay for IA was significantly longer in acute surgical group (5 vs 3 P = 0.05); however, there was no significant difference in duration of total hospital stay (6 vs 6 P > 0.05). For those who had acute surgery the conversion rate was 3% (six) compared with 7% (seven) in delayed surgery group (P = 0.09).

Acute surgery remains the treatment of choice for acute biliary disease. This approach requires a committed team approach but is safe and effective.