Improved management of acute gallstone disease after regional surgical subspecialization

World J Surg. 2008 Dec;32(12):2690-4. doi: 10.1007/s00268-008-9749-8.


Purpose: Acute gallstone disease is a common indication for emergency hospital admission, and evidence now strongly supports early laparoscopic cholecystectomy as the treatment of choice. Recent data from the UK suggest that this is achieved in a minority of cases with a high proportion of patients managed by deferred elective surgery or emergency open cholecystectomy. We present results of a policy of definitive treatment during index admission after subspecialist reorganization of a regional emergency surgical service.

Methods: Data for all emergency gallstone admissions were retrieved from a prospectively collected regional surgical audit database and results were compared from 31 month periods before and after subspecialist service reorganization in August 2002.

Results: A total of 2442 patients were analyzed. Before subspecialization, 458 of 733 patients (62.4%) underwent cholecystectomy during index admission; after subspecialization, cholecystectomy during index admission for biliary colic/acute cholecystitis was achieved in 666 of 817 (81.5%) patients (90.2% laparoscopic, 6.5% conversion rate, and 3.3% primary open cholecystectomy) with a reduction in hospital stay from median 5 to 4 days. The rate of deferred surgery decreased from 37.5% to 18.4%. Early surgery reduced total hospital admission by more than 1 day per patient compared with deferred surgery.

Conclusions: Early laparoscopic cholecystectomy during emergency admission is cost-effective and should be regarded as the standard of care. However, it requires appropriately trained surgeons and availability of a dedicated emergency room, which at present are not consistently provided in all regions of the UK.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cholecystectomy, Laparoscopic*
  • Cohort Studies
  • Emergency Service, Hospital / organization & administration*
  • Female
  • Gallstones / surgery*
  • Humans
  • Length of Stay
  • Male
  • Medical Audit
  • Middle Aged
  • Program Evaluation
  • Regional Medical Programs / organization & administration*
  • Retrospective Studies
  • Specialties, Surgical / organization & administration*
  • Treatment Outcome
  • United Kingdom
  • Young Adult