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Emergency laparoscopic cholecystectomy in an unselected cohort: a safe and viable option in a specialist centre
K Saeb-Parsy1, A Mills, C Rang
1Hinchingbrooke Hospital, Hinchingbrooke Park, Huntingdon, Cambridgeshire, PE29 6NT, United Kingdom. ks10014@cam.ac.uk
Insights
Emergency laparoscopic cholecystectomy (LC) is safe for symptomatic gallstone disease. Specialist surgeons found similar morbidity and mortality rates compared to elective LC, with no increased risk of conversion to open surgery.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Laparoscopic cholecystectomy (LC) for symptomatic gallstone disease is often deferred in acute settings due to perceived risks.
- Historically, acute presentations of gallstone disease led to delayed surgical intervention.
Purpose of the Study:
- To compare morbidity and mortality rates between elective and emergency laparoscopic cholecystectomy (LC).
- To evaluate the safety of 'emergency' LC in a district general hospital setting.
Main Methods:
- Prospective data collection on 423 patients undergoing LC over two years.
- Comparison of elective (n=301) versus 'emergency' (n=122) LC for gallstone-related disease.
- Analysis included patient demographics, inpatient stay, post-operative course, and POSSUM scores.
Main Results:
- Overall morbidity rates were similar: 13.1% for emergency LC vs. 7.3% for elective LC (p=0.088).
- No significant differences in major complications, including conversion to open surgery (0% vs. 0.3%), bile leak, or re-operation.
- 30-day mortality rates were comparable: 0.8% for emergency LC vs. 0% for elective LC.
Conclusions:
- Emergency LC performed by specialist surgeons is safe and comparable to elective LC.
- Acute laparoscopic cholecystectomy does not show increased rates of mortality, morbidity, or conversion to open surgery.
Introduction:
Patients presenting acutely with symptomatic gallstone-related disease have historically had their laparoscopic cholecystectomy (LC) deferred due to perceived increased operative risks in the acute setting, particularly conversion to open surgery. The aim of this study was to compare morbidity and mortality between unselected cohorts of patients undergoing elective and 'emergency' LC in a District General Hospital.
Methods:
All gallstone-related elective and emergency admissions under the care of two specialist laparoscopic surgeons during a two-year period were included. Patients admitted acutely with a diagnosis of biliary colic, acute cholecystitis or gallstone pancreatitis underwent 'emergency' LC during the same admission. Data were collected prospectively on patient demographics, inpatient stay, post-operative course and POSSUM scores.
Results:
423 patients underwent LC, of which 301 (71.1%) were elective and 122 (28.9%) were 'emergency' procedures. ASA grades and POSSUM physiologic scores were similar between the two groups. The overall morbidity rates were similar in the emergency and elective groups (13.1% vs. 7.3%, p = 0.088), and there was no significant difference in the rates of major complications including conversion to open surgery (0% vs. 0.3%, NS), bile leak or re-operation between the two groups. 30-day mortality rates were similar in the two groups (0.8% vs. 0%, NS).
Conclusion:
When performed by specialist laparoscopic surgeons, LC in the acute setting is safe with mortality and morbidity rates, including conversion to open surgery, comparable to elective LC.
