Patients awaiting laparoscopic cholecystectomy--can preoperative complications be predicted?
OBJECTIVE
To determine the nature and incidence of gallstone-related complications arising in patients awaiting laparoscopic cholecystectomy and to formulate a strategy to detect those most in need of urgent intervention.


METHODS
A retrospective analysis of the case notes of 337 consecutive patients undergoing laparoscopic cholecystectomy under a single surgeon in a district general hospital between 1995 and 1999.


RESULTS
Of patients awaiting laparoscopic cholecystectomy, 65 (19.3%) were documented as suffering significant on-going symptoms, of whom 19 (5.6%) required hospital admission or urgent surgical review at median 8.9 weeks (range 0.1-32.3 weeks) after being placed on the waiting list. Factors predictive of symptom recurrence included: (i) initial acute presentation; (ii) diagnoses of jaundice, pancreatitis, or acute cholecystitis; (iii) elevation of amylase or liver function tests; and (iv) small stones on ultrasonography examination.


CONCLUSIONS
A significant proportion of patients awaiting laparoscopic cholecystectomy experience stone-related complications requiring hospital admission. We feel it is possible to reduce this number by selecting those most at risk on the basis of their history and pre-operative investigations for more urgent intervention.
Department of General Surgery, York District Hospital, York, UK. djathornton@yahoo.co.uk
D J A
DJ
Thornton
A
A
Robertson
D J
DJ
Alexander
D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000150:complications* / Q000601:surgery; D017558:Elective Surgical Procedures / Q000379:methods; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment