PTU-121 ‘cholecystectomy’ is it best served hot?

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Abstract

Introduction

The traditional approach to the management of gallstone-related diseases and their acute exacerbations has been conservative for decades.

Introduction

The long standing paradigm of endoscopic extraction of obstructing gallstones with interval cholecystectomy at the end of a cool-down period of 4 to 6 weeks has been challenged in recent years.

Introduction

The National Institute for Health and Care Excellence (NICE, 2014) is recommending that patients with acute cholecystitis should have a laparoscopic cholecystectomy (LC) within a week of admission and the International Association of Pancreatology (IAP, 2013) recommends patients with gallstone pancreatitis to have LC on index admission.

Methods

At our hospital we have established a ‘hot gallbladder’ service in addition to our emergency operating list with once a week dedicated sessions for patients presenting with symptomatic gallstones.

Methods

A prospective database of all ‘hot’ patients is maintained and we have carried out a safety and feasibility study of our 2017 cohort of patients.

Results

In 2017 409 cases with a median age of 58 year (range: 15 to 97) were referred to our department with hard evidence of gall stone disease.

Results

In terms of ‘hot gallbladder’ cases, 117/409 were deemed suitable for the hot gallbladder list, but 19/117 patients declined surgery.

Results

Out of the 98/117 patients 60/98 same admission LCs were performed with good results.

Results

The median age of patients was 45 years (range: 20 to 97). The Male: Female Ratio was 1:2.5

Results

54/60 cases were completed laparoscopically, 4/60 required conversion and 1/60 case was abandoned with a cholecystostomy in-situ. The number of subtotal cholecystectomies was 5/60.

Results

We had no 30 day mortality and there were no biliary tract injuries.

Results

In terms of surgical complications there was 1/60 post-operative haemotoma, 1/60 bile leak and 1/60 intraoperative spillage of gall stones. 3/60 patients required readmission.

Results

The length of stay (LOS) for the ‘hot gallbladder’ cohort was median 6 days (range: 0 to 17). The median length of time between onset of symptoms and presentation to hospital was 1 day (range: 0 to 21 days) and obtaining ultrasound scans took median 1 day (range: 0 to 3). The median waiting time for magnetic resonance cholangiopancreatography (MRCP) was 3 days from admission (range: 1 to 7).

Results

In contrast the median LOS for all gall-stone related admissions in the same period were 6 days with range 0 to 56 days.

Conclusion

Our experience of managing gallstone disease with prompt cholecystectomy during the same admission shows that this approach provides safe and cost-effective patient care.

Conclusion

In order to improve efficiency we are actively working on establishing further ‘hot gall bladder’ lists during the working week and reduction of waiting times for imaging is desirable.

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