scholarly journals P-BN13 How has the COVID pandemic affected outcomes in Elective Laparoscopic Cholecystectomy?An observational study in a UK Upper GI Surgical Unit

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
George Demetriou ◽  
Kasun Wanigasooriya ◽  
Ahmed Elmaradny ◽  
Ammar Al-Najjar ◽  
Mohammad Rauf ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Statistical Significance ◽  
Operating Time ◽  
Bile Leak ◽  
Biliary Colic ◽  
Gallstone Pancreatitis ◽  
Biliary Disease ◽  
Indications For Surgery ◽  
Elective Laparoscopic Cholecystectomy ◽  
Cbd Stone

Abstract Background COVID-19  has a significant impact on elective surgery for benign disease. When routine services resumed in April 2021, surgeons were faced with higher number of complicated cases. The aim of this study is to examine the effect of COVID-19 related delays on the outcomes of patients undergoing elective laparoscopic cholecystectomy (LC) in an upper gastrointestinal unit in the UK. Methods Data were collected retrospectively on consecutive patients undergoing elective LC between 1/3/19 to 1/5/19 (Pre-COVID) and 1/4/21 to 11/6/21 (resumption of elective operating following COVID). The indications for surgery, intraoperative details, postoperative complications, length of stay (LoS) and 30- day readmission were compared between the two cohorts. We divided indications for surgery as inflammatory (acute cholecystitis, gallstone pancreatitis, CBD stone with cholangitis) vs non-inflammatory (biliary colic, gallbladder polyps, CBD stone without cholangitis). Data were analysed using the Mann-Whitney U-test and Chi-square or Fisher’s exact test. A p value of < 0.05 was used for statistical significance.  Results 159 patients were analysed, 106 in Pre-COVID vs 53 in Post-COVID. Both cohorts had similar age, gender, ASA-grade, BMI. 68 (64.2%) of the pre-COVID cohort were operated for a non-inflammatory pathology compared to 19(35.8%) of the post-COVID cohort (p < 0.001). Less patients had total cholecystectomy (subtotal and failed surgery) in the post-COVID cohort [49(92.5%) vs 159 (100%) p = 0.01]. There was no difference in the operating time, conversion to open surgery, the need for drains, and no difference in the Clavien-Dindo grade complications. Two patients in pre- COVID cohort (1.8%) required re-operation for bile-leak and bowel injury and two in the post COVID cohort (3.7%) for bleeding and CBD-injury. There was no difference in day case discharge or 30-day readmission rate.  Conclusions Surgery in the post-COVID cohort was associated with a higher incidence of inflammatory biliary disease, subtotal cholecystectomy and procedure abandoned.  Although the numbers in our study are small they highlight the need for enhanced preoperative assessment in elective biliary surgery as the NHS emerges from the acute phase of the pandemic.

SP3.2.10 Establishing an Emergency Surgical Ambulatory Care (ESAC) pathway for acute laparoscopic cholecystectomies: a single centre experience from a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Neil Donald ◽  
Lavanya Varatharajan ◽  
Kumaran Ratnasingham ◽  
Shashi Irukulla
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Ambulatory Care ◽  
Operating Time ◽  
District General Hospital ◽  
Gallstone Pancreatitis ◽  
Early Laparoscopic Cholecystectomy ◽  
Patient Demographics ◽  
Day Range ◽  
Cost Efficiencies

Abstract Aims Early laparoscopic cholecystectomy is the gold standard for acute cholecystitis and gallstone pancreatitis. In order to deliver this service, a local Emergency Surgical Ambulatory Care (ESAC) pathway with a dedicated ESAC theatre list was established. The aim of this audit was to determine whether ESAC was associated with (1) improved length of stay and (2) cost efficiencies. Methods Consecutive patients who underwent an emergency laparoscopic cholecystectomy between October 2018 to October 2019 were identified. Data related to patient demographics, operating time, complications length of stay (LOS), reason for inpatient stay and re-admissions were collected. A dedicated ESAC service was introduced in July 2020. Outcomes were re-audited (July – December 2020). Results Prior to the introduction of ESAC, 142 patients (42% male, mean age 51 years (range 14 -82 years)) underwent an acute cholecystectomy, of which 13% were discharged on the same day. Median pre-operative LOS was 2 days (range 0-12 days) and median post-operative LOS was 1 day (range 1-16 days). Following the introduction of ESAC, 78 patients (32% male, mean age 49 years (range 22 – 89 years)) underwent an acute cholecystectomy, of which 76% were discharged on the same day and 90% within 1 day. Median pre-operative LOS was 0 days (range 0 to 7 days) and median post-operative LOS was 0 days (range 0-16 days). Conclusions Our results show that the introduction of a dedicated ESAC pathway improved both pre- and post-operative LOS. This subsequently saves approximately £80,000 per annum in hospital bed days.

scholarly journals Angiodysplasia of the Gallbladder: An Unknown Risk Factor for Cholecystolithiasis

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Ivan Švagelj ◽  
Mirta Vučko ◽  
Mato Hrskanović ◽  
Dražen Švagelj
Keyword(s):  
Risk Factor ◽  
Laparoscopic Cholecystectomy ◽  
Literature Review ◽  
Blood Vessels ◽  
Systematic Literature Review ◽  
Incidental Finding ◽  
Common Type ◽  
Biliary Colic ◽  
Unknown Risk ◽  
Elective Laparoscopic Cholecystectomy

Angiodysplasia is a common type of lesion characterized by malformed submucosal and mucosal blood vessels. Angiodysplasia of the gallbladder is extremely rare, usually an incidental finding, with only two cases reported. Laparoscopic cholecystectomy is a curative treatment for angiodysplasia of the gallbladder. Our report describes a case of angiodysplasia of the gallbladder in a patient who underwent elective laparoscopic cholecystectomy for biliary colic because of gallstones, and a systematic literature review. We surmise that angiodysplasia of the gallbladder could be a risk factor for gallstones in younger female patients.

EP.TH.649Identifying Factors Associated with Readmissions after acute biliary admission. Can it help prioritising patients in COVID recovery plans?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Annabelle White ◽  
Andrew Refalo ◽  
Hedda. Widlund ◽  
William Knight ◽  
Husam Ebied
Keyword(s):  
Acute Cholecystitis ◽  
Health Care Services ◽  
Biliary Colic ◽  
Gallstone Pancreatitis ◽  
Biliary Disease ◽  
Readmission Rates ◽  
Patient Demographics ◽  
Care Services ◽  
Increased Risk ◽  
Biliary Pathology

Abstract Aim We conducted a retrospective analysis of readmissions after Acute admission with biliary pathology managed conservatively under the Surgical Team in a teaching London Hospital from 01/03/2019-29/02/2020 Methods We obtained records of patients admitted with Acute Cholecystitis, Biliary Colic, Cholelithiasis, Choledocholithiasis and Gallstone Pancreatitis from the Audit Department between 01/03/2019-29/02/2020, and analysed these regarding patient demographics, comorbidities, duration of index admission, method of diagnosis and management and identified patients’ readmissions Differences in readmission rates based on before mentioned characteristics were studied. Results 157 patients presented between 01/03/2019-29/02/2020, 76 acute cholecystitis, 22 Biliary Colic, 24 Gallstone Pancreatitis, 6 Ascending Cholangitis and 29 Choledocholithiasis The highest representation rate was for patients with choledocholithiasis (41.3%) followed by Acute Cholecystitis (31.5%), 3 patients required cholecystostomies. Baseline characteristics and differences in these characteristics based on occurrence of readmission were studied. 45-60 age group, increasing comorbidity, and biliary obstruction were all associated with increased risk of readmission. Conclusion Readmissions is a substantial burden on the health care services and patient’s safety and QoL We propose adherence to the NICE/BSG Guidelines for management of Acute Biliary Disease, to alleviate this pressure which is already sometimes challenging due to the logistics and resources and would be more challenging with the COVID situation and limited emergency and elective theatre availability so the group at high risk of readmission should be prioritised in the recovery plans.

scholarly journals The dilemma of the duplicated cystic duct: a case report

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Tim Harding ◽  
Enda Hannan ◽  
Conor Brosnan ◽  
William Duggan ◽  
David Ryan ◽  
...  
Keyword(s):  
Cystic Duct ◽  
Bile Leak ◽  
Preoperative Imaging ◽  
Biliary Colic ◽  
Resonance Imaging ◽  
Operative Outcome ◽  
Elective Laparoscopic Cholecystectomy ◽  
Low Threshold ◽  
Abnormal Anatomy ◽  
Rule Out

Abstract We present a rare case of a duplicated cystic duct encountered during an elective laparoscopic cholecystectomy in a patient with biliary colic. Prompt recognition of an intraoperative bile leak followed by thorough examination and recognition of the source allowed for timely and appropriate management of the affected patient with a satisfactory post-operative outcome. Our case is unique by the lack of availability of intraoperative cholangiogram at the time of surgery, which posed a significant diagnostic and therapeutic challenge, and by how aberrant anatomy was confirmed intraoperatively by reviewing prior cardiac magnetic resonance imaging. Unremarkable preoperative imaging does not rule out the presence of abnormal anatomy. Early involvement of a specialist hepatobiliary surgeon is essential in an unexplained bile leak, with a low threshold in converting to an open procedure if there is difficulty in clearly deciphering anatomy.

scholarly journals Cost-Effectiveness of Elective Laparoscopic Cholecystectomy Versus Observation in Older Patients Presenting with Mild Biliary Disease

2014 ◽  
Vol 18 (9) ◽  
pp. 1616-1622 ◽  
Author(s):  
Abhishek D. Parmar ◽  
Mark D. Coutin ◽  
Gabriela M. Vargas ◽  
Nina P. Tamirisa ◽  
Kristin M. Sheffield ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Cost Effectiveness ◽  
Older Patients ◽  
Biliary Disease ◽  
Elective Laparoscopic Cholecystectomy

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 Study of open cholecystectomy for gallbladder disorders

2021 ◽  
Vol 8 (3) ◽  
pp. 826
Author(s):  
Sunil Kumar ◽  
T. Rudra Prasad Reddy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Clinical Judgment ◽  
Open Cholecystectomy ◽  
Standard Procedure ◽  
Demographic Data ◽  
Bile Leak ◽  
Laparoscopic Approach ◽  
Biliary Colic ◽  
Medical College ◽  
Conversion To Open Cholecystectomy

Background: Cholecystectomy is one of the most common surgeries done worldwide. Most common indication is biliary colic due to cholelithiasis. Presently most cholecystectomies are done by laparoscopic approach, however conversion to open cholecystectomy is needed in few circumstances and there are some absolute indications for open cholecystectomy where laparoscopic procedure can’t be done.Methods: This is a prospective observational study of 50 open cholecystectomies operated during March 2017 to Feb 2019 in our medical college. Various data including demographic data of patients, different indications, post-operative complications were documented and analyzed.Results: Mean age of the patients was 40.58 (16-65) years. Female patients were more in number 32 (64%) when compared with males. Maximum patients were in the age group 31-40 years accounting to 17 (34%) of study population. Pain abdomen 24 (48%) was the chief presenting complaint. Cholelithiasis 38 (76%) was the major indication for surgery. Complications like bile leak, bleeding, subphrenic abscess and infection occurred in 04 (08%) patients. Total four cases of laparoscopic cholecystectomy were converted to open cholecystectomy. Mean hospital stay was 7.48 (5-14) days.Conclusions: Even though laparoscopic cholecystectomy is the gold standard in the present era, it is important that the surgeon is also competent in doing open cholecystectomy. Certain conditions require planned open cholecystectomy as the standard procedure. In difficult laparoscopic cases, the surgeon must take timely decision to convert to the open technique. Surgeons experience and proper clinical judgment skills are important in difficult cases.

scholarly journals 237 Massive Subcapsular Intra-hepatic Haematoma Post-laparoscopic Cholecystectomy: A Rare Complication of a Common Procedure

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
E Saad ◽  
L O'Connell
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Rare Complication ◽  
Postoperative Bleeding ◽  
Bile Leak ◽  
Decisive Role ◽  
Biliary Colic ◽  
Post Discharge ◽  
Common Procedure ◽  
The Right ◽  
Hepatic Haematoma

Abstract Abstract Laparoscopic cholecystectomy (LC) is currently considered the gold standard for the management of symptomatic gallbladder stones disease. Specific complications remain challenging, particularly postoperative bleeding, bile leak, and bile duct injury. We report a rare case of a giant intrahepatic subcapsular haematoma (ISH) complicating LC. Case Presentation A 59-year-old female presented with symptomatic biliary colic. Her past medical history was noted for obesity (BMI > 50). She underwent an elective LC with an uncomplicated intraoperative course; however, post-operatively she developed hypovolaemic shock with an acute haemoglobin drop requiring fluid resuscitation and blood transfusion. Emergency CT revealed a massive subcapsular haematoma measuring 21cm×3.1cm× 17cm at the right liver margin without evidence of ongoing bleeding. She was managed conservatively- as per a tertiary hepatobiliary surgery centre’s advice- with meticulous clinical observations, serial monitoring of haemoglobin, and repeat CT to assess for interval progressions. She progressed well with conservative management and did not require surgical or radiological intervention. A follow-up liver US performed eight weeks post-discharge confirmed a complete resolution. Conclusions Giant ISH is an exceedingly rare but life-threatening complication following LC which merits special attention. Our case demonstrates the necessity of close postoperative monitoring of patients undergoing LC and considering the possibility of ISH in those who experience a refractory postoperative hypotension. It also highlights the decisive role of diagnostic imaging in securing a timely and accurate diagnosis of post LC-ISH

scholarly journals P-BN14 Differences in rate of complications between emergency and elective laparoscopic cholecystectomy at district general hospital

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Anas Belhasan ◽  
Rebecca Wookey ◽  
Adam Atkinson ◽  
Hatim Albirnawi ◽  
Ajay Gupta
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Statistical Significance ◽  
Surgical Techniques ◽  
Complication Rates ◽  
Biliary Disease ◽  
Data Set ◽  
Average Hospital ◽  
Operative Complication ◽  
Significant Difference ◽  
Elective Group

Abstract Background Current NICE guidelines recommend healthy low risk patients who present with acute biliary disease should be offered laparoscopic cholecystectomy on the same index admission. The increased complexity of the acute operations may impact on the operative complication rates; hence the aim of this study is to evaluate and compare the operative complication rates between elective and emergency laparoscopic cholecystectomies and additionally to assess the difference in surgical techniques comparing complete cholecystectomy versus subtotal versus open procedures. Methods Retrospectively, data was collected from emergency and elective Laparoscopic Cholecystectomies completed in the period 01/01/2021-01/06/2021 at the Queen Elizabeth Hospital Gateshead. The data set was gathered from an electronic theatre database and the individual cases were sub-analyzed further by delving into the electronic patient records database.  Statistical analysis done by using Excel 2010. Results The average age of both groups was 50 years. There wasn’t a statistical significance on the rate of complication between the elective Vs emergency cholecystectomies (Elective 2%, Emergency 9% P = 0.17). Out of 42 Elective procedures, 4 had Sub-total cholecystectomy Vs 3 out of 42 patients on the emergency group who had Subtotal cholecystectomy (9% Vs 7%), implying there was no significant difference noted between the two groups. Average hospital stays was 5.6 days for the acute presentation with biliary disease Vs 0.14 days on the planned elective group. 2% of the elective group were noted to have a surgical drain inserted during the operation; whilst the emergency cohort had a slightly higher rate at 5%. Conclusions Overall there was no significant difference noted between the surgical complications arising in emergency cholecystectomy compared to planned surgeries.  In addition to this the data also suggests that there is negligible difference in the rates of sub-total cholecystectomies in both cohorts.

scholarly journals P-EGS07 Two years of Acute Biliary Admissions at a tertiary care centre over the Covid-19 pandemic: a closed loop audit with implementation of an acute referral system

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Andrew Refalo ◽  
Annabelle White ◽  
Hedda Widlund ◽  
Husam Ebied
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Patient Outcomes ◽  
Waiting Times ◽  
Tertiary Care ◽  
Referral System ◽  
Biliary Colic ◽  
Gallstone Pancreatitis ◽  
Tertiary Care Centre ◽  
Readmission Rates

Abstract Background AUGIS recommends patients diagnosed with acute cholecystitis and gallstone pancreatitis to receive a laparoscopy cholecystectomy on the index admission, ideally within 72 hours of presentation. Early laparoscopic cholecystectomy is associated with better patient outcomes and reduced readmission rates. During the Covid-19 pandemic emergency surgery, if possible was avoided. These patients are referred for an elective cholecystectomy, however waiting times can be lengthy with readmissions common prior to surgery.  Methods We performed a closed loop audit on acute biliary admissions to a central London tertiary care centre. We assessed waiting times to laparoscopic cholecystectomy for patients fit for surgery as well as readmissions prior to surgery. The data was collated over a one-year period (01/03/2019 to 29/02/2020), analysed and presented to the senior biliary surgery team. A dedicated e-referral system for patients who did not receive a laparoscopic cholecystectomy on index admission was implemented. Post intervention admissions were re-audited over a second year (01/03/2020- 30/01/2021) and re-analysed to assess the effect of the intervention.   Results A total of 111 patients with acute cholecystitis, 52 with gallstone pancreatitis, 34 with biliary colic, 36 with choledocholithiasis and 10 with ascending cholangitis, were included. Prior to implementation of our referral system average waiting time to laparoscopic cholecystectomy was 98.2 weeks, reduced to 47.7 weeks post referral system implementation. Reduction in waiting times resulted in readmission rates reduced by: 23.3% in Choledocholithiasis; 17.4% in Biliary Colic;   16.7% in Ascending Cholangitis; 12.8% in Acute Cholecystitis and 8.3% in Gallstone pancreatitis.  Conclusions Admissions with acute biliary colic compose a substantial workload. The COVID-19 pandemic has resulted in a preference for elective versus emergency laparoscopic cholecystectomy. However, delay in surgery results in a readmission burden on emergency surgery departments and worse patient outcomes hence laparoscopic cholecystectomy should be performed as soon as possible following initial admission. This audit demonstrates that a dedicated biliary referral system reduced waiting time which translates to a reduction in admission rates. The importance of this referral system is magnified in the recovery phase of the pandemic where we continue to recover waiting times.

Sign in / Sign up

Export Citation Format

Share Document