PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of annrcseLink to Publisher's site
 
Ann R Coll Surg Engl. 2002 January; 84(1): 20–22.
PMCID: PMC2503768

Consequences of prolonged wait before gallbladder surgery.

Abstract

The aim of this study was to document the morbidity associated with long waiting times for laparoscopic cholecystectomy and to relate this to the nature of initial presentation either routine out-patient consultation or emergency admission with acute symptoms. This study was performed over a 50-month period in a DGH (serving a population of 320,000) which lacked sufficient operating capacity to allow routine early cholecystectomy after emergency admission. A total of 387 patients underwent cholecystectomy but 22 of these had an early operation after initial emergency admission with signs of peritonitis and were excluded from the study. The median waiting time for cholecystectomy in this study population of 365 patients was 170 days (range, 6-484) days. Of these 365 patients, 246 (67.4%) were listed for surgery after initial out-patient assessment (out-patient cohort) and 119 (32.6%) were diagnosed after an index emergency admission with symptomatic gallstone disease (emergency cohort). Of the 365 patients, 42 (11.5%) had one or more emergency admissions (57 admissions) with gallstone-related complications whilst on the waiting list for surgery. Complications were acute cholecystitis/biliary colic (n = 40), jaundice/cholangitis (n = 8), acute pancreatitis (n = 6) and perforated gallbladder (n = 3). Re-admissions with gallstone-related complications were much more common in patients whose initial presentation had been as an emergency. Thus, 34 of the 119 emergency cohort (28.5%) required re-admission with complications whilst only 8 of 246 (2.8%) elective cohort were re-admitted. Of the 34 re-admissions in the emergency cohort, 22 occurred within 6 weeks of their discharge from hospital. Median total and postoperative stay were significantly shorter (P < 0.001) in the elective cohort (3 and 2 days, respectively) than the emergency cohort (10 and 3 days, respectively). These results document the high incidence of complications experienced by patients waiting for an elective laparoscopic cholecystectomy. Morbidity is highest in patients with an initial emergency admission. These results suggest that cholecystectomy should be offered to all patients presenting as an emergency with symptomatic gallstones on admission.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (458K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.
 
 

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, Trede M, Troidl H. The European experience with laparoscopic cholecystectomy. Am J Surg. 1991 Mar;161(3):385–387. [PubMed]
  • Zucker KA, Flowers JL, Bailey RW, Graham SM, Buell J, Imbembo AL. Laparoscopic management of acute cholecystitis. Am J Surg. 1993 Apr;165(4):508–514. [PubMed]
  • Wilson RG, Macintyre IM, Nixon SJ, Saunders JH, Varma JS, King PM. Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis. BMJ. 1992 Aug 15;305(6850):394–396. [PMC free article] [PubMed]
  • Bender JS, Zenilman ME. Immediate laparoscopic cholecystectomy as definitive therapy for acute cholecystitis. Surg Endosc. 1995 Oct;9(10):1081–1084. [PubMed]
  • Burnett W. The management of acute cholecystitis. Aust N Z J Surg. 1971 Aug;41(1):25–30. [PubMed]
  • Mallet-Guy P, Welch C, Ungeheur E, Encke A. Chirurgie der akuten Cholecystitis. Langenbecks Arch Chir. 1976 Sep 23;341(3):151–160. [PubMed]
  • du Plessis DJ, Jersky J. The management of acute cholecystitis. Surg Clin North Am. 1973 Oct;53(5):1071–1077. [PubMed]
  • Van der Linden W, Edlund G. Early versus delayed cholecystectomy: the effect of a change in management. Br J Surg. 1981 Nov;68(11):753–757. [PubMed]
  • Norrby S, Herlin P, Holmin T, Sjödahl R, Tagesson C. Early or delayed cholecystectomy in acute cholecystitis? A clinical trial. Br J Surg. 1983 Mar;70(3):163–165. [PubMed]
  • Järvinen HJ, Hästbacka J. Early cholecystectomy for acute cholecystitis: a prospective randomized study. Ann Surg. 1980 Apr;191(4):501–505. [PubMed]
  • Kiviluoto T, Sirén J, Luukkonen P, Kivilaakso E. Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet. 1998 Jan 31;351(9099):321–325. [PubMed]
  • Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998 Apr;227(4):461–467. [PubMed]
  • Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, Lau WY. Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 1998 Jun;85(6):764–767. [PubMed]
  • Rau HG, Meyer G, Maiwald G, Schardey M, Merkle R, Lange V, Schildberg FW. Konventionelle oder laparoskopische Cholecystektomie zur Behandlung der akuten Cholecystitis? Chirurg. 1994 Dec;65(12):1121–1125. [PubMed]
  • Kum CK, Goh PM, Isaac JR, Tekant Y, Ngoi SS. Laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 1994 Nov;81(11):1651–1654. [PubMed]
  • Kum CK, Eypasch E, Lefering R, Paul A, Neugebauer E, Troidl H. Laparoscopic cholecystectomy for acute cholecystitis: is it really safe? World J Surg. 1996 Jan;20(1):43–49. [PubMed]
  • Koo KP, Thirlby RC. Laparoscopic cholecystectomy in acute cholecystitis. What is the optimal timing for operation? Arch Surg. 1996 May;131(5):540–545. [PubMed]
  • Hunter JG. Acute cholecystitis revisited: get it while it's hot. Ann Surg. 1998 Apr;227(4):468–469. [PubMed]
  • Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg. 1997 Jun;21(5):540–545. [PubMed]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England