Setting up a surgical complex gallstone service in a non-HPB unit.

Area of Science:

• Hepatobiliary Surgery
• Surgical Education
• Gastroenterology

Background:

• Complex gallstone disease poses higher risks during laparoscopic cholecystectomy.
• Specialized hepatopancreaticobiliary (HPB) units traditionally manage these cases, leading to potential burdens.
• Developing local expertise in upper gastro-intestinal (UGI) units can improve patient access to care.

Purpose of the Study:

• To establish a mentorship program for complex gallstone disease management.
• To reduce the workload on specialist HPB units.
• To enable UGI units to provide local treatment for complex gallstone disease.

Main Methods:

• A service level agreement facilitated mentorship from an HPB unit to two surgeons in a UGI unit.
• Eight sessions of mentored operating were provided, with additional support available for complications.
• The program focused on patients with complex gallstone histories.

Main Results:

• Fourteen patients with complex gallstone disease were treated between November 2015 and May 2017.
• Patient histories included previous cholecystostomy, common bile duct stones, fistulas, Mirrizzi's syndrome, prior abdominal surgery, and comorbidities.
• One post-operative complication required re-operation, and one minor wound infection occurred.

Conclusions:

• A mentorship scheme effectively reduces the burden on specialist HPB units.
• Complex gallstone disease can be safely managed in a UGI unit with appropriate support.
• This model enables local treatment, improving access to care for patients with complex gallstone disease.