Document Detail


Removing symptomatic gallstones at their first emergency presentation.
MedLine Citation:
PMID:  18634735     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Early operations for symptomatic gallstones are gaining favour as the complication rate is thought to be lower and it reduces the overall morbidity. This study was performed to clarify how frequently early operations were being performed and what benefits resulted. PATIENTS AND METHODS: Case notes of 171 patients who underwent laparoscopic cholecystectomy at Princess Alexandra Hospital Harlow were retrospectively reviewed. They were grouped according to their initial diagnosis (cholelithiasis, acute cholecystitis) and the delay to surgery (early, interval). Forty-one cases were excluded as they either had incomplete notes or the initial diagnosis was a different manifestation of gallstones such as pancreatitis. Those receiving interval operations were then grouped according to the mode of their initial presentation. A total of 130 case notes were analysed. RESULTS: The delay for an interval operation was 3-6 months compared with less than 2 weeks for early operations. Of patients with acute cholecystitis, 43% had early operations but only 12% of patients with cholelithiasis. Waiting for interval operations was associated with multiple re-admissions equivalent to an average of one extra presentation to accident and emergency per patient. This was particularly marked if the initial presentation was to accident and emergency rather than outpatients (P = 0.003). Complication rates were also higher in the interval group. CONCLUSIONS: Early cholecystectomy on the next available list is likely to reduce morbidity and the long-term in-patient burden so should be recommended for all patients presenting as an emergency with symptomatic gallstones.
Authors:
Hanny A Anwar; Qamar A Ahmed; Howard A Bradpiece
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of the Royal College of Surgeons of England     Volume:  90     ISSN:  1478-7083     ISO Abbreviation:  Ann R Coll Surg Engl     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-18     Completed Date:  2008-09-02     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  7506860     Medline TA:  Ann R Coll Surg Engl     Country:  England    
Other Details:
Languages:  eng     Pagination:  394-7     Citation Subset:  IM    
Affiliation:
Department of General and Laparoscopic Surgery, Princess Alexandra Hospital, Harlow, UK. hannyanwar@yahoo.co.uk
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Cholecystectomy / methods*
Cholecystitis, Acute / diagnosis,  surgery*
Early Diagnosis
Gallstones / diagnosis,  surgery*
Humans
Middle Aged
Postoperative Complications / prevention & control*
Prognosis
Retrospective Studies
Time Factors
Treatment Outcome
Waiting Lists
Comments/Corrections
Comment In:
Ann R Coll Surg Engl. 2009 May;91(4):354-5   [PMID:  19416592 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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