Urgent cholecystectomy for acute cholecystitis in a district general hospital - is it feasible?
M N Khan1, I Nordon, A S K Ghauri
1Department of General Surgery, Salisbury District Hospital, Salisbury, UK. mkhan702@aol.com
Insights
Urgent laparoscopic cholecystectomy for acute cholecystitis is safe and effective in district general hospitals. This approach, using a dedicated pathway, yielded excellent outcomes with no conversions and minimal complications.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Health Services Research
Background:
- Laparoscopic cholecystectomy is standard for gallstones but debated for acute cholecystitis due to risks.
- Tertiary centers report good outcomes, prompting investigation in district general hospitals.
Purpose of the Study:
- To evaluate the feasibility and safety of an urgent laparoscopic cholecystectomy pathway for acute cholecystitis in a district general hospital.
- To assess outcomes including complication rates, conversion rates, and hospital stay.
Main Methods:
- A prospective database was established for patients undergoing urgent laparoscopic cholecystectomy for acute cholecystitis over 8 months.
- A dedicated ultrasound service ensured prompt diagnosis.
- Data collected included demographics, operative findings, laboratory results, ERCP timing, complications, and hospital stay.
Main Results:
- 64 patients (21 male, 43 female, median age 51) underwent laparoscopic cholecystectomy during index admission.
- No conversions to open surgery were required; median time from admission to operation was 3 days.
- Two bile leaks and two superficial wound infections occurred; no common bile duct injuries were reported.
Conclusions:
- Urgent laparoscopic cholecystectomy for acute cholecystitis is a feasible and safe option in district general hospitals.
- Adherence to a care pathway and a multidisciplinary, consultant-led service ensures safe practice.
- Outcomes are comparable to those reported in the literature, supporting its use in this setting.
Introduction:
Laparoscopic cholecystectomy has become the gold standard for treatment of symptomatic gall stone disease. However, its place remains controversial in the management of acute cholecystitis due to a high reported incidence of bile leaks and conversion rate. Tertiary referral centres have reported good results. We present a series of cases after the introduction of an urgent cholecystectomy pathway in a district general hospital.
Patients And Methods:
A practice of urgent cholecystectomy for acute cholecystitis was introduced by three consultant general surgeons. All prospective patients having an urgent laparoscopic cholecystectomy for acute cholecystitis, over an 8-month period were entered into a database. A dedicated ultrasound service was instituted to provide prompt diagnosis in these patients. Their demographic details, operative findings, laboratory results were recorded in a prospective database. Timing of ERCP, postoperative complications and conversion rate and hospital stay were also noted.
Results:
There were 64 patients in the study with a median age of 51 years (range, 21-84 years). There were 21 males and 43 females. All patients underwent laparoscopic cholecystectomy during the index admission. Eleven patients had pre-operative ERCP and 12 patients had on-table cholangiogram. There were no conversions. Postoperative ERCP was required in six patients. The median time interval between admission and operation was 3 days (range, 2-7 days). There were two bile leaks but no common bile duct injury. There were two cases of superficial wound infection. One patient required re-operation for small bowel obstruction secondary to a port site hernia.
Conclusions:
Urgent laparoscopic cholecystectomy for acute cholecystitis is a feasible treatment option in a district general hospital. A safe practice can be ensured by adherence to a care pathway and a multidisciplinary, consultant-delivered service. Urgent cholecystectomy service can be provided safely in a district general hospital with outcomes comparable to previously published literature.
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