scholarly journals O-EGS02 Effective use of afternoon Day Case Theatre Lists for Emergency Laparoscopic Cholecystectomy on Emergency Surgery Ambulatory Care (ESAC) Pathway

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Rui Wei ◽  
Mishal Shahid ◽  
Jessica Barton ◽  
Lian Williams ◽  
Marianne Hollyman
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Admission ◽  
Ambulatory Care ◽  
Emergency Surgery ◽  
Gallstone Disease ◽  
Low Flow ◽  
Biliary Colic ◽  
Day Case ◽  
Hospital Admission Rate ◽  
Symptomatic Gallstones

Abstract Background Gallstone disease is a common entity and affects up to 10-15% of the European population. The majority of these cases are asymptomatic but approximately 20% will develop complications such as severe biliary colic, cholecystitis, choledocholithiasis and pancreatitis. Early cholecystectomy in patients suffering from symptomatic gallstones can improve post-operative outcomes, avoid re-attendance and reduce overall length of hospital stay. We describe how two afternoon day case theatre lists were successfully utilised to prevent surgical admissions by enabling laparoscopic cholecystectomy on an urgent basis. Methods A sustainable pathway for symptomatic gallstones was introduced to Emergency Surgery Ambulatory Care (ESAC). Patients presenting with acute symptoms, well enough for ambulatory care, were referred to ESAC for diagnosis and management. Patients fit for surgery underwent pre-operative assessment before being operated on one of two weekly afternoon lists. A standardised, evidence-based approach was used for all laparoscopic cholecystectomies to ensure homogeneity of technique and patient care. This included pre-incision local anaesthetic, low flow and pressures intra-operatively, adequate analgesia to-take-home, and follow-up telephone consultation at 48hrs. Prospective data collection began in 2019 looking at hospital admission rate and 30-day re-presentation. Results Analysis was performed on data collected from September 2019 to July 2021. 151 patients had laparoscopic cholecystectomies, 107 were female and 44 male. Age range was 18-83 (median age 49) and median time to operation was 3 days. Overall, the spectrum of gallstone disease was 81 biliary colic, 44 cholecystitis, 20 pancreatitis and 6 choledocholithiasis. 18 patients were admitted post-operatively with length of stay ranging 1-6 days (median 1.5 days). 17 patients re-presented within 30 days, mainly for abdominal or pleuritic chest pain, although one patient required ERCP for CBD stones and another had pancreatitis. Conclusions Emergency surgery for symptomatic gallstone disease can be performed successfully on a day case basis. At our centre, the rate of post-operative admission was 12% and 30-day re-presentation was 11%. Standardisation of referrals, assessment and operative technique can achieve excellent outcomes with low rates of hospital admission and post-operative complications.

scholarly journals Acute Laparoscopic Cholecystectomy: Delays in Acute Surgery and Cost Analysis of Aproposed New Service

2011 ◽  
Vol 93 (7) ◽  
pp. 261-265
Author(s):  
AJ Cockbain ◽  
AL Young ◽  
E McGinnes ◽  
GJ Toogood
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Meta Analysis ◽  
Gallstone Disease ◽  
Cochrane Review ◽  
Length Of Hospital Stay ◽  
Biliary Colic ◽  
Complication Rates ◽  
Acute Surgery ◽  
Symptomatic Gallstone Disease

Acute laparoscopic cholecystectomy (ALC) is widely considered the most appropriate management for patients presenting with acute cholecystitis as supported by a recent meta-analysis and Cochrane review. Although the benefit of ALC is less clear in patients with biliary colic, few would disagree that earlier cholecystectomy is preferable for most patients with symptomatic gallstone disease. ALC has similar complication rates to elective laparoscopic cholecystectomy (ELC) and a reduced total length of hospital stay. Recurrent symptoms from untreated gallstone disease are common, with the risk of developing more severe complications such as acute cholecystitis, acute pancreatitis or cholangitis while waiting for an operation. It has been reported that patients awaiting ELC after an acute admission have significantly more general practitioner (GP) attendances than those who receive ALC, that they have an average of one emergency department attendance for symptom recurrence and that one in six requires hospital admission due to the severity of recurrent symptoms.

scholarly journals P-EGS14 From Gallstone Disease to Cholecystectomy: An audit looking at the waiting times for cholecystectomy in a small District General Hospital

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Jacob Mewse ◽  
Virginia Ledda ◽  
Ellie Connor ◽  
Peter Frank Mason
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Waiting Time ◽  
Negative Impact ◽  
Elective Surgery ◽  
Waiting Times ◽  
Gallstone Disease ◽  
Gastrointestinal Surgery ◽  
Emergency Operation ◽  
Biliary Colic ◽  
Emergency General Surgery

Abstract Background Gallstone-related disease accounts for a third of emergency general surgery admissions and referrals. The average waiting time for acute gallstone presentations to laparoscopic cholecystectomy is about 7 days in England. This audit aims to identify emergency admissions and compare local management to the Association of Upper Gastrointestinal Surgery of Great Britain and Ireland (AUGIS) guidelines standards with a focus on waiting times for laparoscopic cholecystectomy (LC). Where AUGIS standards were not met, number of re-admissions and complications were identified. A cost analysis was also completed looking at the overall costs of delayed treatment. Methods We identified all patients admitted as an emergency between September 2019 and September 2020 with gallstone-related pathology. Patients not referred to the surgical team, with negative Ultrasound Scans (USS) or known HPB malignancy were excluded. The patients were divided into a pre- COVID -19 and during COVID-19 category (respectively before and after March 2020), to identify whether the cancellation to non- urgent elective surgery (due to COVID-19) had caused further delays or complications. Each patient’s management was compared to AUGIS guidelines depending on their diagnosis at presentation (biliary colic, cholecystitis, cholangitis, gallstone-related pancreatitis), focusing on the timing between presentation and LC. Results A total of 99 patients were identified. Of the patients presenting with biliary colic (n = 9 pre-COVID, n = 5 during COVID), none underwent LC within 72 hours from presentation as recommended by AUGIS. Of the patients presenting with cholecystitis (n = 20 pre-COVID and n = 16 during COVID), none had LC within the recommended 72 hours. 5 patients in each COVID group had LC, with a significantly longer waiting time compared to the pre-COVID group. Re-admissions and complications were similar for the cholecystitis patients in both COVID groups. In the gallstone-related pancreatitis group, only 1 patient underwent LC within the recommended 2 weeks. Conclusions This audit showed that locally we are failing to meet AUGIS guidelines for LC within 72 hrs, 2 weeks or 6 weeks both pre and during COVID. This has caused re-admissions of patients with cholecystitis, pancreatitis and perforated gallbladders. Factors that cause delay are limited access to USS, limited staff and theatre availability. To improve outcomes, it is necessary to implement a hot gallbladder service with dedicated theatre slots. A change in the overall perception of LC is also needed: this is should be considered an emergency operation as its delay has a significant negative impact on patients’ outcomes.

scholarly journals Primary Choledocholithiasis 15 Years Postcholecystectomy

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Michael Simon ◽  
Irfan Nazir Hassan ◽  
Dhanasekaran Ramasamy ◽  
David Wilson
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Standard Treatment ◽  
Case Reports ◽  
Gallstone Disease ◽  
The Elderly ◽  
Western Society ◽  
Bile Duct Stones ◽  
Symptomatic Gallstones

Gallstone disease is extremely prevalent in the western society with laparoscopic cholecystectomy (LC) being the standard treatment for patients with symptomatic gallstones. The prevalence of common bile duct (CBD) stones with concomitant gallstones increases with age from 8–15% in patients <60 years of age and up to 60% in the elderly. There have been only a few case reports of postcholecystectomy bile duct stones occurring more than 10 years following surgery in the literature. Most of these reports describe the presence of stones within the gallbladder/cystic duct remnant or secondary to migrating surgical clips.

scholarly journals Laparoscopic Cholecystectomy as a Day Surgery Procedure

1996 ◽  
Vol 24 (2) ◽  
pp. 231-236 ◽  
Author(s):  
R. J. Singleton ◽  
G. E. Rudkin ◽  
G. A. Osborne ◽  
D. S. Watkin ◽  
J. A. R. Williams
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Recovery Room ◽  
Admission Rate ◽  
Day Surgery ◽  
Nausea And Vomiting ◽  
Day Case ◽  
Hospital Admission Rate ◽  
Admission Rates ◽  
Surgery Patient ◽  
At Home

Outcome is presented for 40 consecutive laparoscopic cholecystectomies performed in a public teaching hospital day surgery unit. The unanticipated hospital admission rate on the day of surgery was 17.5% (seven patients) and the majority of these (12.5%; five patients) were due to surgery-related considerations. Two other admissions were due to nausea and vomiting. One patient was admitted to hospital on the second postoperative day with nausea and vomiting. Procedure duration for the day cases averaged 98 minutes (SD25; range 60–167). Recovery room times before discharge averaged 272 minutes (SD 58; range 125–365). Each day surgery patient averaged 3.3 postoperative home visits from community nurses. Most patients (94%) mobilized at home by the second postoperative day and 85% resumed normal activities of daily living by two weeks. At follow-up, 25 patients (76%) stated they were happy to spend the first night at home, but seven (21%) would have preferred to remain in hospital for the first postoperative night. Laparoscopic cholecystectomy can be performed successfully as a day–case procedure, but long operating and recovery room times and potentially high admission rates suggest that these factors should be considered in cost equations for day-case management of this procedure.

scholarly journals P-EGS29 Is an ambulatory emergency general surgery management pathway of biliary disease more cost effective than a traditional approach? A matched case series study

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Harriet Standing ◽  
Katie Boag ◽  
Michael Hughes ◽  
Nasira Amtul
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Ambulatory Care ◽  
Clinical Picture ◽  
Care Pathway ◽  
Case Series ◽  
Biliary Colic ◽  
Biliary Disease ◽  
Patient Pathways ◽  
Case Series Study ◽  
Wide Range

Abstract Background Patients presenting with biliary colic with or without deranged liver function tests (LFT’s) requiring surgery have traditionally been managed as inpatients or on an elective basis. Emergency surgery has previously been associated with higher costs in comparison to outpatient, elective management.   Methods Thirteen patients presenting as an emergency with a diagnosis of cholecystitis, with or without deranged LFTs, who underwent different patient pathways resulting in laparoscopic cholecystectomy were identified randomly over 1 month period. They were then matched into groups to compare elective, inpatient and ambulatory care pathway management for patients with similar demographics and clinical picture. The costs of each patient’s journey, from acute presentation to discharge following laparoscopic cholecystectomy was calculated in conjunction with the patient level information costing team (PLICS). Results Three matched groups of patients were identified: 50-60M, 65-75F with normal LFTs, 60F with obstructive LFT’s. Each patient underwent an ultrasound scan of the upper abdomen, laparoscopic cholecystectomy with additional investigations dependent on the group and clinical picture. In each group, when elective, emergency inpatient or ambulatory care pathways were compared there was a consistent cost difference. The order from most expensive to cheapest was: inpatient management, elective management, ambulatory care.  The difference in costs was primarily linked with emergency department assessment and inpatient bed stays with cost saving of up to £5000 in one group when comparing inpatient stay to ambulatory emergency care management. Conclusions The use of an ambulatory emergency general surgical pathway for patients with a variety of biliary colic presentations including those with deranged LFT’s is economically comparable and potentially advantageous to more traditional and established patient management pathway options in a number of patient demographics across age, gender and pathology. An ambulatory care pathway, when developed and used correctly can provide significant cost savings to a wide range of patients.  

scholarly journals 398 Outcome of Laparoscopic Cholecystectomy in Patients Over 80 Years Old

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Gumaa ◽  
A Hunt ◽  
D Karunaratne ◽  
S Shresta ◽  
B Al-Robaie
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallstone Disease ◽  
District General Hospital ◽  
The Elderly ◽  
Biliary Colic ◽  
Old Patients ◽  
Medical Background ◽  
Admission Data ◽  
Emergency Group ◽  
Elective Group

Abstract Background Gallstone disease is a common cause of morbidity in old patients. Conservative treatment is usually the first line of treatment due to concerns about the risk of surgery. In our study we are trying to assess the outcome of laparoscopic cholecystectomy in patients over 80 years old. Method Retrospective cohort study done in a large district general hospital where good number of laparoscopic cholecystectomy is done every year. Main outcome is Mortality, return to theatre and post op ITU admission. Data collected from patients records. Results 74 patients in total were operated on. 14 operations were done as emergency (during the same inpatient admission). Indication for surgery varied between cholecystitis, pancreatitis and biliary colic. But the main indication in the emergency group was acute cholecystitis. 55 % of the patients had significant medical background with ASA 3. 30 days mortality was 0 in both emergency and elective groups. 2 patients required ITU admission post op, mainly for premorbid status, and both were in the emergency group. There was only one return to theatre in the emergency group for washout. 90% of the elective group patients were done as day case with no post op complications. Conclusions Laparoscopic cholecystectomy is safe operation to be done in the elderly population. ITU admission is mainly because of the patient’s co-morbidities so patients should be selected carefully and have proper pre op assessment.

scholarly journals CBD Stone Formation Over Migrated Surgical Clip: A Rare Complication Developed Fourteen Years after Laparoscopic Cholecystectomy

2019 ◽  
Vol 10 (03) ◽  
pp. 188-190
Author(s):  
Parth Shah ◽  
Pravin Rathi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Foreign Bodies ◽  
Stone Formation ◽  
Rare Complication ◽  
Biliary Colic ◽  
Surgical Clips ◽  
Surgical Clip ◽  
Symptomatic Gallstones ◽  
History Of ◽  
Cbd Stone

AbstractLaparoscopic cholecystectomy (LC) is currently the treatment of choice for symptomatic gallstones. Migration of surgical clips into common bile duct (CBD) is a rare complication after LC. Migrated surgical clips may lead to further complications like cholangitis, choledocholithiasis. We report a rare case of CBD stone formed over migrated surgical clips, 14 years after LC. A 41-year-old male with history of LC 14 years back, presented with repeated episodes of biliary colic. Computed tomography (CT) scan abdomen showed CBD stones with metallic foreign bodies and prominent CBD. Patient was managed successfully with endoscopic retrograde cholangiopancreatography. Patient became asymptomatic thereafter. This case is a rare complication developed after a very commonly performed surgery.

Gallstone disease

2018 ◽  
pp. 401-414
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Obstructive Jaundice ◽  
Gallstone Disease ◽  
Acute Cholangitis ◽  
Biliary Colic ◽  
Ultrasound Scan ◽  
Bile Duct Stones ◽  
Clinical Presentations ◽  
Laparoscopic Bile Duct Exploration

Gallstone disease is common with clinical presentations including biliary colic, cholecystitis, and obstructive jaundice. Acute cholangitis and pancreatitis are other complications. Ultrasound scan and MRCP as well as endoscopic ultrasound are investigation modalities. Medical treatment of gallstones with ursodeoxycholic acid is discussed as well as laparoscopic cholecystectomy with its risks and benefits. The prevalence of bile duct stones is around 10–20%. Strategies for investigation and management are discussed, including ERCP and laparoscopic bile duct exploration.

scholarly journals An Effective Approach to Improving Day-Case Rates following Laparoscopic Cholecystectomy

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
M. G. Clarke ◽  
T. Wheatley ◽  
M. Hill ◽  
G. Werrett ◽  
G. Sanders
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Social Factors ◽  
Readmission Rate ◽  
Cost Effective ◽  
Day Case ◽  
Readmission Rates ◽  
Conversion Rates ◽  
Cost Effective Treatment ◽  
Symptomatic Gallstones ◽  
Elective Cholecystectomy

Background. Day-case laparoscopic cholecystectomy (LC) is a safe and cost-effective treatment for gallstones. In 2006, our institution recorded an 86% laparoscopic, 10% day-case, and 5% readmission rate. A gallbladder pathway was therefore introduced in 2007 with the aim of increasing daycase rates.Methods. Patients with symptomatic gallstones, proven on ultrasound, were referred to a specialist-led clinic. Those suitable for surgery were consented, preassessed, and provided with a choice of dates. All defaulted to day case unless deemed unsuitable due to comorbidity or social factors.Results. The number of cholecystectomies increased from 464 in 2006 to 578 in 2008. Day-case rates in 2006, 2007, 2008, and June 2009 were 10%, 20%, 30%, and 61%, respectively. Laparoscopic and readmission rates remained unchanged. Conversion rates for elective cholecystectomy fell from 6% in 2006 to 3% in 2009.Conclusions. Development of a gallbladder pathway increased day-case rates sixfold without an associated increase in conversion or readmission rates.

scholarly journals Two eras of laparoscopic cholecystectomy: an experience of 3000 cases

2017 ◽  
Vol 4 (9) ◽  
pp. 2920
Author(s):  
Jahangir Sarwar Khan ◽  
Raheel Ahmad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallstone Disease ◽  
Invasive Procedure ◽  
Minimal Invasive ◽  
Surgical Department ◽  
Medical College ◽  
Symptomatic Gallstones ◽  
Group A ◽  
Group B ◽  
Cbd Injury

Background: Laparoscopic cholecystectomy (LC) a minimal invasive procedure is regarded as gold standard for gallstone disease for many years. With increase learning curve of surgeons, the incidence of complications of this procedure decreases significantly. The purpose of study was to compare the experiences of Laparoscopic cholecystectomy performed.Methods: It was a retrospective cohort study conducted in Surgical Department, Rawalpindi Medical College and author's surgical clinic. From 1st January 1998 to 31st December 2014. Total 3000 patients of Laparoscopic cholecystectomy were divided into 2 groups. First 1500 cases (operated between January 1998 to December 2007) in Group A and next 1500 cases (operated between January 2008 to December 2014) in Group B. Preoperative diagnosis, intraoperative findings and injuries especially incidence of CBD injuries with post-operative complications and their management were evaluated.Results: Out of 3000 cases 2585 (86.1%) were females and 415 (13.8%) were males. Total 18 (0.6%) cases had CBD injury during LC. 17 cases were in group A which decreased significantly to 1 case in Group B. Mean operative time was 30 minutes. Wound infection remained the most common postoperative complication.Conclusions: In our setup, the burden of laparoscopic cholecystectomy for symptomatic gallstones have increased with very low incidence of complications.

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