An integrative model of short‐term dynamic psychotherapy (STDP) is presented that assimilates interventions from a variety of therapy orientations to accelerate patient improvement. Affect phobia therapy (APT) is a name given to McCullough's STDP to highlight the main treatment focus and to guide therapists to the most efficient and effective interventions. This treatment model is based on the hypothesis that conflicts about feelings, or “affect phobias,” are the fundamental issues underlying many Axis I and Axis II disorders. Systematic desensitization, or stepwise exposure to feelings and defense response prevention, is hypothesized to be the fundamental agent of therapeutic change. APT focuses primarily on the resolution of affective conflicts in a psychodynamic framework, but videotape review and process studies of this STDP model have discovered that interventions from cognitive, behavior, Cestalt, and experiential therapy, as well as self‐psychology, have been instrumental in patient change. Therapy is made briefer by clarifying treatment objectives, simplifying the selection criteria, and using principles of systematic desensitization for the resolution of affect phobias.

BackgroundLaparoscopic common bile duct exploration (LCBDE) has emerged as a recommended alternative to endoscopic retrograde cholangiopancreatography (ERCP) for the management of choledocholithiasis. However, its use in the elderly has been limited, and evidence of its safety and efficacy in these patients is yet to be established. This study describes our experience of LCBDE in elderly patients, analysing the safety and efficacy of this technique in comparison to younger patients.MethodsAll patients undergoing laparoscopic cholecystectomy (LC) with LCBDE for choledocholithiasis in our unit between January 2015 and January 2017 were included. Data pertaining to patient demographics, comorbidities, investigations, operative technique and outcomes were analysed. Patients were divided into 2 groups based on age (Group A:<65 years vs Group B: >/ = 65 years) for comparative analysis.Results124 patients (Group A: 65, Group B: 59) were included. Group B were more co-morbid and had a higher ASA grade than Group A. However, there was no significant difference between groups in rates of conversion to open or complications, including bile leak (3.1% vs 5.1%, p = 0.67), retained stone (4.6% vs 1.7%, p = 0.62), or complications according to Clavien-Dindo classification (p = 0.78). Re-intervention rates were also similar between groups (7.7% vs 3.4%, p = 0.44 and 3.1% vs 3.4%, p = 1.0 respectively), as was length of stay.ConclusionDespite higher frequency of comorbidities and ASA grade, LCBDE in elderly patients is safe and effective, and has similar outcomes to younger patients. Therefore elderly patients with choledocholithiasis should be offered LCBDE as an alternative to ERCP.

Patients who had small gallstones were significantly more likely to represent with retained CBD stones. Multiple gallstones within the gallbladder also seemed to be significant risk factor. We were unable to correlate an emergency procedure, patient sex or age as being higher risk groups for retained CBD stones. If gallstone number and size can accurately be determined by pre-operative imaging then it is patients with multiple small stones that should be most rigorously targeted for intra operative CBD assessment and action if found.

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Aim The purpose of this study was to evaluate whether patients with a high BMI can undergo safe day case LC for cholecystitis compared to groups of patients with a lower BMI. Setting NHS District General Hospital, UK. Methods A retrospective review of 2391 patients who underwent an attempted day case LC between 1 January 2009 and 15 August 2015 was performed. Patients were divided into five groups depending on their BMI. Inclusion criteria were patients undergoing elective day case laparoscopic cholecystectomy with cholecystitis on histology. The endpoints were complication requiring readmission and postoperative length of stay (LOS). Results There were 2391 LCs performed in the time period of which 1646 were eligible for inclusion. These LCs were classified as 273 (16.9%), 608 (37.8%), 428 (26.6%), 208 (12.9%), and 91 (5.66%) patients in the groups with BMI values of 18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and >40, respectively. Average BMI was 30.0 (±5.53, 19–51) with an average postoperative LOS of 0.86, and there was no difference between the BMI groups. Overall complication rate was 4.3%; there was no significance between BMI groups. Conclusions Increased BMI was not associated with worse outcomes after day case LC.