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Is Specialisation Needed in Laparoscopic Cholecystectomy? A Retrospective Cohort Study of 5122 Patients
Insights
Laparoscopic cholecystectomy (LC) by specialist upper gastrointestinal (UGI) surgeons shows improved outcomes compared to broader surgical groups. This study highlights lower complication rates and no 30-day mortality for UGI specialists performing LC.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Minimally Invasive Surgery
Background:
- Gallstone disease is prevalent, with laparoscopic cholecystectomy (LC) being a common elective procedure.
- UK audits indicate LC is performed by various surgical specialists, not exclusively upper gastrointestinal (UGI) surgeons.
- Varied surgical expertise may influence patient outcomes in LC procedures.
Purpose of the Study:
- To compare the outcomes of LC performed by specialist UGI surgeons against data from the CholeS study and other international reports.
- To determine if UGI specialist surgeons achieve superior outcomes in LC patients.
- To evaluate the safety and efficacy of UGI specialist-led LC.
Main Methods:
- A retrospective analysis of 5122 LC procedures performed by two UGI consultant surgeons between 1999-2019 and 2014-2019.
- Inclusion criteria focused on LC performed by UGI surgeons; excluded were patients lost to follow-up, procedures by trainees, and gallbladder cancer cases.
- Key outcome measures included bile leak, bile duct injuries, bleeding, infectious complications, mortality, and conversion rates, analyzed using statistical tests with a 95% confidence interval and p-value of 0.05.
Main Results:
- The study involved 5122 LCs (86% female, median age 48), with 72% performed as day surgery.
- No 30-day mortality was recorded; complication rates were low: 0.15% biliary leak, 0.19% common bile duct (CBD) injuries, 0.02% conversions, and 0.33% abandoned procedures.
- Significant differences in complication rates were observed when compared to the CholeS report, favoring the UGI specialist group.
Conclusions:
- Laparoscopic cholecystectomy performed by specialist UGI surgeons is associated with favorable outcomes.
- UGI specialist-led LC demonstrates a low risk of bile duct injury and zero 30-day mortality.
- Specialization in UGI surgery may enhance patient safety and procedural success in laparoscopic cholecystectomy.
Abstract:
Background: Gallstone disease is a common problem and laparoscopic cholecystectomy (LC) is a common elective procedure. This operation was performed by a general surgeon, colorectal surgeons, breast and vascular surgeons according to the largest UK's audit (CholeS study). Objectives: To compare the outcomes of laparoscopic cholecystectomy performed by a specialist upper gastrointestinal (UGI) surgeon to that of CholeS and large international studies. Our hypothesis is: UGI specialist is producing better outcomes for LC patients. Methods: All patient who underwent LC between 1999 and 2019 at one hospital by an UGI consultant and 2014-2019 at another hospital by another UGI consultant surgeon were included. The inclusion criteria were LC performed by UGI surgeon. Lost to follow up, procedures done by trainees and gallbladder cancer patients were excluded. The outcome measures of bile leak, bile duct injuries, bleeding, infectious complications, bowel injuries, vascular injuries and pseudoaneurysms, neuralgia, port site hernia, mesenteric haematoma, 30-day mortality and conversion to open were reported. Statistical tests were used to assess the significant differences, the confidence interval was 95% and the p-value was taken as 0.05. Results: Two UGI specialists performed 5122 LC, 4396 (86%) were female and 715 (14%) male. The age was 13-93 year (median of 48 years). 3681 (72 %) was done as a day surgery case. 1431(28%) as an inpatient and 287 (5.6%) emergency LC. There was no death in the 30 days periods of surgery, 8 (0.15%) biliary leak from the duct of Luschka, 4 (0.19%) common bile duct (CBD) injuries, 9(0.02%) conversions and 17(0.33%) procedures were abandoned. There were significant differences in the above complications between our study and the CholeS report. Conclusions: Laparoscopic cholecystectomy is associated with acceptable outcomes, low risk of bile duct injury and no mortality when performed by a specialist upper GI surgeon.
