The incidence, operative difficulty and outcomes of staged versus index admission laparoscopic cholecystectomy and bile duct exploration for all comers: a review of 5750 patients

Welsh, S., Nassar, A. H.M. and Sallam, M. (2022) The incidence, operative difficulty and outcomes of staged versus index admission laparoscopic cholecystectomy and bile duct exploration for all comers: a review of 5750 patients. Surgical Endoscopy, 36(11), pp. 8221-8230. (doi: 10.1007/s00464-022-09272-0) (PMID:35507063) (PMCID:PMC9613731)

Abstract

Background: The timing of laparoscopic cholecystectomy (LC) for emergency biliary admissions remains inconsistent with national and international guidelines. The perception that LC is difficult in acute cholecystitis and the popularity of the two-session approach to pancreatitis and suspected choledocholithiasis result in delayed management. Methods: Analysis of prospectively maintained data in a unit adopting a policy of “intention to treat” during the index admission. The aim was to study the incidence of previous biliary admissions and compare the operative difficulty, complications and postoperative outcomes with patients who underwent index admission LC. Results: Of the 5750 LC performed, 20.8% had previous biliary episodes resulting in one admission in 93% and two or more in 7%. Most presented with biliary colic (39.6%) and acute cholecystitis (27.6%). A previous biliary history was associated with increased operative difficulty (p < 0.001), longer operating times (86.9 vs. 68.1 min, p < 0.001), more postoperative complications (7.8% vs. 5.4%, p = 0.002) and longer hospital stay (8.1 vs. 5.5 days, p < 0.001) and presentation to resolution intervals. However, conversion and mortality rates showed no significant differences. Conclusion: Index admission LC is superior to interval cholecystectomy and should be offered to all patients fit for general anaesthesia regardless of the presenting complaints. Subspecialisation should be encouraged as a major factor in optimising resource utilisation and postoperative outcomes of biliary emergencies.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Nassar, Mr Ahmad
• Authors: Welsh, S., Nassar, A. H.M., and Sallam, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Surgical Endoscopy
• Publisher: Springer
• ISSN: 0930-2794
• ISSN (Online): 1432-2218
• Published Online: 04 May 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Surgical Endoscopy 36(11): 8221-8230
• Publisher Policy: Reproduced under a Creative Commons License