NDLI: Index admission laparoscopic cholecystectomy for patients with acute biliary symptoms: results from a specialist centre.

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Index admission laparoscopic cholecystectomy for patients with acute biliary symptoms: results from a specialist centre.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Young, Alastair L. Cockbain, Andrew J. White, Alan W. Hood, Adrian Menon, Krishna V. Toogood, Giles J.
Spatial Coverage	England
Description	Country affiliation: United kingdom Author Affiliation: Young AL ( Hepatobiliary and Transplant Unit, Lincoln Wing, St James's University Hospital, Leeds, UK.)
Abstract	BACKGROUND: Index admission laparoscopic cholecystectomy (ALC) is the treatment of choice for patients admitted with biliary symptoms but is performed in less than 15% of these admissions. We analysed our results for ALC within a tertiary hepatobiliary centre. METHODS: Data from all cholecystectomies carried out under the care of the two senior authors from 1998 to 2008 were prospectively collected and interrogated. RESULTS: 1710 patients underwent cholecystectomy of which 439 (26%) were ALC. Patients operated on acutely did not have a significantly different complication rate (P= 0.279; 4% vs.3%). Factors predicting complications were abnormal alkaline phosphatase (ALP) (P= 0.037), dilated common bile duct (CBD) (P= 0.026), cholangitis (P= 0.040) and absence of on table cholangiography (OTC) (P= 0.011). There were no bile duct injuries. Patients undergoing ALC had a higher rate of conversion to an open procedure (P < 0.001:10% vs.3%). The proportion of complicated disease was higher in the ALC group (P < 0.001; 70% vs.31%). Only complicated disease (P= 0.006), absence of OTC (P < 0.001) and age greater than 65 years (P < 0.001) were predictive of conversion on multivariate analysis. CONCLUSIONS: Laparoscopic cholecystectomy can be performed safely in patients with acute biliary symptoms and should be considered the gold standard for management of these patients thus avoiding avoidable readmissions and life-threatening complications. A higher conversion rate to an open procedure must be accepted when treating more complicated disease. It is the severity of disease rather than timing of surgery which most probably predicts complications and conversions.
File Format	HTM / HTML
ISSN	1365182X
e-ISSN	14772574
DOI	10.1111/j.1477-2574.2010.00163.x
Journal	HPB
Issue Number	4
Volume Number	12
Language	English
Publisher	Elsevier
Publisher Date	2010-05-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Gastroenterology Biliary Tract Diseases Surgery Cholecystectomy, Laparoscopic Patient Admission Acute Disease Complications Diagnosis Chi-square Distribution Adverse Effects Elective Surgical Procedures Hospitals, University Length Of Stay Patient Selection Prospective Studies Risk Assessment Risk Factors Severity Of Illness Index Time Factors Comparative Study Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Hepatology Gastroenterology

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