Index admission laparoscopic cholecystectomy for patients with acute biliary symptoms: results from a specialist centre.
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.
Young
Alastair L
AL
Hepatobiliary and Transplant Unit, Lincoln Wing, St James's University Hospital, Leeds, UK.
Cockbain
Andrew J
AJ
White
Alan W
AW
Hood
Adrian
A
Menon
Krishna V
KV
Toogood
Giles J
GJ
D000208:Acute Disease; D000368:Aged; D001660:Biliary Tract Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016009:Chi-Square Distribution; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D017558:Elective Surgical Procedures; D004739:England; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D018579:Patient Selection; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome