Skip to main content

Advertisement

SpringerLink
Log in

Improved Management of Acute Gallstone Disease After Regional Surgical Subspecialization

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Acute gallstone disease is a common indication for emergency hospital admission, and evidence now strongly supports early laparoscopic cholecystectomy as the treatment of choice. Recent data from the UK suggest that this is achieved in a minority of cases with a high proportion of patients managed by deferred elective surgery or emergency open cholecystectomy. We present results of a policy of definitive treatment during index admission after subspecialist reorganization of a regional emergency surgical service.

Methods

Data for all emergency gallstone admissions were retrieved from a prospectively collected regional surgical audit database and results were compared from 31 month periods before and after subspecialist service reorganization in August 2002.

Results

A total of 2442 patients were analyzed. Before subspecialization, 458 of 733 patients (62.4%) underwent cholecystectomy during index admission; after subspecialization, cholecystectomy during index admission for biliary colic/acute cholecystitis was achieved in 666 of 817 (81.5%) patients (90.2% laparoscopic, 6.5% conversion rate, and 3.3% primary open cholecystectomy) with a reduction in hospital stay from median 5 to 4 days. The rate of deferred surgery decreased from 37.5% to 18.4%. Early surgery reduced total hospital admission by more than 1 day per patient compared with deferred surgery.

Conclusions

Early laparoscopic cholecystectomy during emergency admission is cost-effective and should be regarded as the standard of care. However, it requires appropriately trained surgeons and availability of a dedicated emergency room, which at present are not consistently provided in all regions of the UK.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. NHS Institute for Innovation and Improvement (2006) Delivering quality and value: focus on cholecystectomy. Department of Health, London

    Google Scholar 

  2. Van der Linden W, Edlund G (1981) Early versus delayed cholecystectomy: the effect of a change in management. Br J Surg 68:753–757

    Article  PubMed  Google Scholar 

  3. Cheruvu CV, Eyre-Brook IA (2002) Consequences of prolonged wait before gallbladder surgery. Ann R Coll Surg Engl 84:20–22

    PubMed  CAS  Google Scholar 

  4. Somasekar K, Shankar PJ, Foster ME, Lewis MH (2002) Costs of waiting for gall bladder surgery. Postgrad Med J 78:668–669

    Article  PubMed  CAS  Google Scholar 

  5. Johansson M, Thune A, Nelvin L, Stiernstam M, Westman B, Lundell L (2005) Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg 92:44–49

    Article  PubMed  CAS  Google Scholar 

  6. Lo CM, Liu CL, Fan ST, Lai EC, Wong J (1998) Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 227:461–467

    Article  PubMed  CAS  Google Scholar 

  7. Kiviluoto T, Siren J, Luukkonen P, Kivilaakso E (1998) Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 351:321–325

    Article  PubMed  CAS  Google Scholar 

  8. Navez B, Mutter D, Russier Y, Vix M, Jamali F, Lipski D et al (2001) Safety of laparoscopic approach for acute cholecystitis: retrospective study of 609 cases. World J Surg 25:1352–1356

    Article  PubMed  CAS  Google Scholar 

  9. Kum CK, Goh PM, Isaac JR, Tekant Y, Ngoi SS (1994) Laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 81:1651–1654

    Article  PubMed  CAS  Google Scholar 

  10. Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC et al (1998) Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 85:764–767

    Article  PubMed  CAS  Google Scholar 

  11. Chandler CF, Lane JS, Ferguson P, Thompson JE, Ashley SW (2000) Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg 66:896–900

    PubMed  CAS  Google Scholar 

  12. Lau H, Lo CY, Patil NG, Yuen WK (2006) Early versus delayed-interval laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis. Surg Endosc 20:82–87

    Article  PubMed  CAS  Google Scholar 

  13. Gurusamy KS, Samraj K (2006) Early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Cochrane Database Syst Rev 4:CD005440

    Google Scholar 

  14. David GG, Al-Sarira AA, Willmott S, Deakin M, Corless DJ, Slavin JP (2008) Management of acute gallbladder disease in England. Br J Surg 95:472–476

    Article  PubMed  CAS  Google Scholar 

  15. Allgood PC, Bachmann MO (2006) Effects of specialisation on treatment and outcomes in screen-detected breast cancers in Wales: cohort study. Br J Cancer 94:36–42

    Article  PubMed  CAS  Google Scholar 

  16. Martin-Ucar AE, Waller DA, Atkins JL, Swinson D, O’Byrne KJ, Peake MD (2004) The beneficial effects of specialist thoracic surgery on the resection rate for non-small-cell lung cancer. Lung Cancer 46:227–232

    Article  PubMed  Google Scholar 

  17. Ng VV, Tytherleigh MG, Fowler L, Farouk R (2006) Subspecialisation and its effect on the management of rectal cancer. Ann R Coll Surg Engl 88:181–184

    Article  PubMed  Google Scholar 

  18. Mercer SJ, Knight JS, Toh SK, Walters AM, Sadek SA, Somers SS (2004) Implementation of a specialist-led service for the management of acute gallstone disease. Br J Surg 91:504–508

    Article  PubMed  CAS  Google Scholar 

  19. Senapati PS, Bhattarcharya D, Harinath G, Ammori BJ (2003) A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK. Ann R Coll Surg Engl 85:306–312

    Article  PubMed  CAS  Google Scholar 

  20. Addison PDR, Getgood A, Paterson-Brown S (2001) Separating elective and emergency surgical care (the emergency team). Scot Med J 46:48–50

    PubMed  CAS  Google Scholar 

  21. Elson D, Sa’adedin F, Partridge R, Feltham N, Paterson-Brown S, Wilson RG et al (2004) Separation of upper and lower gastrointestinal surgery. Br J Surg 91(Suppl 1):67

    Google Scholar 

  22. Peng WK, Sheikh Z, Nixon SJ, Paterson-Brown S (2005) Role of laparoscopic cholecystectomy in the early management of acute gallbladder disease. Br J Surg 92:586–591

    Article  PubMed  CAS  Google Scholar 

  23. Birkmeyer JD, Sun Y, Wong SL, Stukel TA (2007) Hospital volume and late survival after cancer surgery. Ann Surg 245:777–783

    Article  PubMed  Google Scholar 

  24. Association of Surgeons of Great Britain and Ireland (2007) Emergency general surgery: the future. A consensus statement

Download references

Acknowledgement

Conflict of interest: SJN and SPB are Consultant Surgeons in the unit from which the data were retrieved.

Author information

Authors and Affiliations

  1. Clinical and Surgical Sciences (Surgery), Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK

    D. J. Simpson, A. M. Wood, S. J. Nixon & S. Paterson-Brown

  2. Department of Coloproctology, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK

    H. M. Paterson

Authors
  1. D. J. Simpson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. M. Wood
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. M. Paterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. J. Nixon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Paterson-Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. M. Paterson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Simpson, D.J., Wood, A.M., Paterson, H.M. et al. Improved Management of Acute Gallstone Disease After Regional Surgical Subspecialization. World J Surg 32, 2690–2694 (2008). https://doi.org/10.1007/s00268-008-9749-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-008-9749-8

Keywords

Search

Navigation