PWE-138 The incidence and management of cystic duct stones: the intra-operative cholangiogram is more than just a diagnostic tool

Abstract

Introduction Conversion to open surgery used to be a marker of difficult cholecystectomy. With increasing experience conversion rate has reduceed significantly, but the difficulties remain the same. Both, conversion and difficult cholecystectomy have impact on operation time. The aim of this study is to identify the major predictive factors for "difficult" cholecystectomies, which are either continued laparoscopically or subsequently converted. Methods A retrospective review of all the consecutive laparoscopic cholecystectomies, performed by a single surgeon, in a district general hospital in the UK, from January to December 2011, was undertaken. Association of intra-operative difficulties or conversion to open surgery, with the following factors was studieddAge, gender, liver function tests, jaundice, cholecystitis, pre-operative ERCP, pancreatitis, and radiological findings. Results During the study period 180 patients underwent cholecystectomy, of which 10 were converted to open surgery (5.6%), while 30 (16.6%) others were deemed "difficult dissections" but the operations were still completed laparoscopically. Previous cholecystitis (n¼45) seems to be the most important predictor of difficulty, with 71% of patients requiring conversion or being considered a "difficult dissection." Another very useful predictor is previous ERCP (n¼14), with 64.5% of these patients being either conversions or "difficult dissections." The conversion rate and difficult laparoscopic dissection rate was 8% and 24% respectively for men (n¼37) and 5% and 15% for women (n¼143). Among the patients with previous pancreatitis, none required conversion and 29% had difficult dissections. The conversion and difficult dissection rates increased with age (7% and 4% for age<40, 20% and 1% for age 40e60, and 20.5% and 9.5% for age>60 respectively). Conclusion Bile duct stones managed with pre-operative ERCP, cholecystitis and male gender appear to be the major predictors of difficult cholecystectomies/conversion to open surgery. This ability to predict the difficulty of the procedure might help the surgeon prepare for any technical difficulties that may arise, organise the theatre list more efficiently, and offer the patient more accurate information and counselling prior to the procedure. Introduction Biliary pain is a common presentation in the acute surgical take and the surgical clinic. In patients with normal ultrasound findings, symptoms can sometimes be disregarded as being non-specific. We propose that in this cohort, a HIDA scan is a useful investigation, and patients with a positive test have good results following cholecystectomy. Methods We obtained reports of all HIDA scans with an abnormal ejection fraction (EF <40%) performed in our centre from 15 May 2007 to 28 December 2010. This database was cross-linked with a prospectively-maintained database and electronic records of patients undergoing cholecystectomy in the same period. All patients with a positive HIDA who went on to have laparoscopic cholecystectomy (LC) were followed-u...