title: Index laparoscopic cholecystectomy for acute admissions with cholelithiasis provides excellent training opportunities in emergency general surgery.
abstract: BACKGROUND
  There is minimal data on the outcome of early laparoscopic cholecystectomy (LC) for acute gallbladder disease when performed by trainees. This study assesses the outcomes of a policy of same admission LC incorporated into a surgical training programme in a major teaching hospital.
  
  
  METHODS
  447 index LCs performed over a 3-year period were reviewed retrospectively. The indications, operating surgeon, operating time, use of IOC, conversion rates, reasons for conversion and post-operative stay were analysed. Multivariate analysis of reasons for conversion was performed.
  
  
  RESULTS
  150 LCs were performed by consultants and 297 by registrars; 67 were performed by year 1-3 specialist registrars (SpR) and 230 by year 4-6 SpRs. The indications were biliary colic (n=7), acute cholecystitis (n=180), chronic cholecystitis (n=260), carcinoma (n=1). No difference was found in demographics, operating time (105 min Vs 115 min), use of IOC (34% Vs 29%; P=0.2) and post-operative stay (2 days Vs 1 day) between consultants and registrars. The conversion rates were higher for consultants compared to registrars (29 (19%) Vs 28 (9%), P=0.004). The overall conversion rate was 11%. There were no bile duct injuries. Predictors for conversion were CRP>50 at admission and acute cholecystitis.
  
  
  CONCLUSIONS
  In a teaching hospital setting most acute admission LCs (66%) were performed by trainees. A step wise training programme with active consultant supervision of all index LCs results in low morbidity, low conversion rates, and a short post-operative stay for acute gallbladder disease. This model of same admission cholecystectomy provides a good training opportunity in emergency general surgery.
authors.affiliation: Directorate of General Surgery, Ninewells Hospital & Medical School, Ninewells Avenue, Dundee, Scotland DD1 9SY.
authors.forename: P
authors.initials: P
authors.lastname: Sanjay
authors.forename: J
authors.initials: J
authors.lastname: Moore
authors.forename: E
authors.initials: E
authors.lastname: Saffouri
authors.forename: S A
authors.initials: SA
authors.lastname: Ogston
authors.forename: C
authors.initials: C
authors.lastname: Kulli
authors.forename: F M
authors.initials: FM
authors.lastname: Polignano
authors.forename: I S
authors.initials: IS
authors.lastname: Tait
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000193:education / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D013502:General Surgery / Q000193:education*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012189:Retrospective Studies; D006113:United Kingdom; D055815:Young Adult