This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Implementation of a specialist‐led service for the management of acute gallstone disease. BJS 2004; 91: 504-508.
Published: 27th February 2004
Authors: S. J. Mercer, J. S. Knight, S. K. C. Toh, A. M. Walters, S. A. Sadek, S. S. Somers et al.
Background
The ‘gold standard’ treatment for acute cholecystitis and biliary colic requiring hospital admission is urgent laparoscopic cholecystectomy. This is not routinely available in all hospitals.
Method
A retrospective audit of emergency admissions with acute cholecystitis or biliary colic from January to December 2000 led to the development and implementation of a specialist‐led protocol for the urgent management of acute gallstone disease. A second audit was carried out covering the 6 months after implementation.
Results
One hundred and fifty‐eight patients were admitted with acute cholecystitis or biliary colic in the first audit period and 110 in the second interval. The rate of cholecystectomy at index admission increased from 37·3 to 67·3 per cent, at a median of 3 days after admission, and the conversion rate to open surgery fell from 32 to 12 per cent. Median hospital stay fell from 9 to 5·5 days, and the unplanned readmission rate decreased from 19·0 to 3·6 per cent.
Conclusion
Urgent cholecystectomy for the management of acute gallstone disease is feasible and achievable in an acute services hospital with a specialist upper gastrointestinal team. It can lead to a reduced conversion rate, shorter hospital stay, fewer unplanned readmissions, an acceptable operating time and a low complication rate. The protocol is recommended for implementation in other hospitals. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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