Management of acute gallbladder disease in England

David, G. G.; Al-Sarira, A.; Willmott, S.; Deakin, Mark; Corless, D.; Slavin, John

doi:10.1002/bjs.5984

Cited by 65 publications

(62 citation statements)

References 14 publications

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“…Additionally, surgeons having more than 10 years' experience and surgeons having performed fewer than 500 LC converted more frequently. This could mean that, with experience, surgeons identified risks more rapidly during LC, while surgeons less skilled in laparoscopic techniques recognized that the laparoscopic approach might be technically too demanding in difficult cases of AC and preferred conversion to a primary open approach [3,[11][12][13][14]. Local disease-related factors, such as gangrenous cholecystitis or coexistent CBDS, were major predictive factors of conversion, in agreement with previous reports [13,14].…”

Section: Discussionsupporting

confidence: 83%

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Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium

Navez

Ungureanu²,

Michiels³

et al. 2012

Surg Endosc

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Background Laparoscopic cholecystectomy is considered nowadays as the standard management of acute cholecystitis (AC). However, results from multicentric studies in the general surgical community are still lacking. Methods A prospective multicenter survey of surgical management of AC patients was conducted over a 2-year period in Belgium. Operative features and patients' clinical outcome were recorded. The impact of independent predictive factors on the choice of surgical approach, the risk of conversion, and the occurrence of postoperative complications was studied by multivariate logistic regression analysis.

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Section: Discussionsupporting

confidence: 83%

“…stay, early laparoscopic cholecystectomy (LC) has come to be considered the standard treatment of AC [1][2][3]. Although an open approach remains a valid option in complicated cases (e.g., gangrenous cholecystitis, etc.…”

mentioning

confidence: 99%

Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium

Navez

Ungureanu²,

Michiels³

et al. 2012

Surg Endosc

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“…Hospital Episode Statistics (HES) data shows that only 15% of patients underwent cholecystectomy during the first emergency admission with acute gallbladder disease between April 2003 and March 2004. 13 Although this may be due to a lack of emergency theatre time, there may also have been a shortage of experienced laparoscopic biliary surgeons in the past. There is also a perceived view among some theatre staff and anaesthetists that LC should be regarded as a routine procedure.…”

Section: Discussionmentioning

confidence: 99%

Early Laparoscopic Cholecystectomy Service Provision is Feasible and Safe in the Current UK National Health Service

Agrawal

Battula

Barraclough

et al. 2009

annals

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Ann R Coll Surg Engl 2009; 91: 660-664 660Acute biliary disease secondary to gallstones is a frequent cause for acute surgical admission. Recent literature review suggests that early (within 7 days of onset of symptoms) laparoscopic cholecystectomy (LC) for acute gallstone disease is safe 1 and cost-effective. 2 Early LC has also been shown to improve quality of life.3 Few hospitals in the UK routinely perform early LC for acute gallstone diseases due to lack of manpower and resources. 4 Time restrictions on emergency theatre lists often means that patients are discharged after an index emergency admission with plans for re-admission for a delayed-interval cholecystectomy. This often leads to multiple interim re-admissions as an emergency with gallstone-related complications.

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“…This is exceptionally higher than the 2.4% and 14.6% readmission rates reported by McGillicuddy et al and David et al respectively. 17,19 Approximately half of the patients who had a PC then proceeded to a cholecystectomy with a conversion rate of 23% and a complication rate of 15%. The conversion rate is consistent with previously published data.…”

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confidence: 99%

Patient outcomes after treatment with percutaneous cholecystostomy for biliary sepsis

Flexer

Peter

Durham-Hall

et al. 2014

annals

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1 Bradford Teaching Hospitals NHS Foundation Trust, UK 2 Doncaster and Bassetlaw Hospitals NHS Foundation Trust, UK ABSTRACT INTRODUCTION Acute cholecystitis is among the most common general surgical presentations. There is a cohort of patients who develop systemic sepsis and complications of acute cholecystitis. These patients are often elderly and co-morbid. Conservative management with percutaneous cholecystostomy has been shown to be a safe and effective management option in the acute setting. However, there is currently no consensus for the further management of these patients. In particular, there is a paucity of data on readmission rates and subsequent operative or non-operative management. METHODS A retrospective study was carried out of patients treated with a percutaneous cholecystostomy for biliary sepsis over a three-year period in a UK teaching hospital. Outcome measures were subsequent operative or conservative management, conversion rates, operative complications and readmission rates. RESULTS Twenty-five patients had a percutaneous cholecystostomy for the treatment of acute biliary sepsis. The median follow-up duration was 35 months. Thirteen patients (52%) had operative treatment. In the operative group, 6/13 had a laparoscopic cholecystectomy, 2/13 had a planned open cholecystectomy, 2/13 had abandoned procedures and 3/13 had a converted procedure. Complications in the operative group included: postoperative mortality (1/13), common bile duct injury requiring drainage and endoscopic stenting (1/13) and one patient required readmission with recurrent pain. In the non-operative group, 5/12 patients were readmitted with biliary sepsis, 5/12 had no readmissions, 1/12 died in the community and 1/12 was readmitted with biliary colic. CONCLUSIONS Percutaneous cholecystostomy is a recognised treatment modality for elderly, co-morbid patients with biliary sepsis. Nevertheless, the readmission rate in this group is relatively high at 5/12 (42%). Patients who undergo subsequent operative management have a conversion rate of 3/13 (23%) and a significant complication rate of 2/13 (15%). The further management of patients having undergone percutaneous cholecystostomy requires careful consideration on an individual case basis. The P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) may aid decision making.

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Management of acute gallbladder disease in England

Cited by 65 publications

References 14 publications

Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium

Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium

Early Laparoscopic Cholecystectomy Service Provision is Feasible and Safe in the Current UK National Health Service

Patient outcomes after treatment with percutaneous cholecystostomy for biliary sepsis

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