Prophylactic fundoplication may not be necessary in neurologically impaired children undergoing gastrostomy for feeding purposes. It increases the postoperative morbidity compared to gastrostomy alone in this group of children. It should be offered selectively to children continuing to have reflux-related complications after gastrostomy. The technical difficulties with a pre-existing gastrostomy can be overcome in the hands of experienced laparoscopic surgeons.

Methods: An eleven-year prospective database included 1482 emergency admissions (53%) was maintained. Most biliary emergencies are referred as a matter of protocol. The work load is recognized in job planning, with agreement to 40% elective surgery. Theatre utilization is maximized through using on call and CEPOD lists. Results: Other consultants or hospitals referred 87%. 72% were first presentations. Admission-to-referral was 3.9 days, 68% undergoing surgery within 5 days. 67% had suspected choledocholithiasis, 35% undergoing ductal explorations. 47% of cholecystectomies were done on open elective lists, 28.4% while on call and 24.6% in CEPOD theatre. The mean operation time was 84 minutes and mean hospital stay 6.9 days. We recorded 4.5% complications, 6 re-laparoscopies, 3 deaths and one conversion. Conclusion: Emergency biliary surgery during the index admission for all patients presenting with cholelithiasis with or without CBD stones is possible with low rates of complications if a dedicated team exists, timely referral occurs and access to theatre is made flexible by the provision of open lists. There are clear benefits to clinical and to other outcome parameters such as waiting times, number of episodes, hospital stay and presentation to resolution intervals.