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I read this paper on the timing of surgery for symptomatic gallstone disease with interest. However, based on the data presented, I think the conclusions reached must be greeted with caution. If patients, particularly presenting with acute cholecystitis, were informed that they could be discharged to return for a day-case laparoscopic procedure or they could remain as an in-patient for an average of 5 days before having an operation that would have a significantly higher change of being converted (P = 0.007, Fisher' exact test) with a longer postoperative stay (data not given), I wonder how many of them would choose the latter option? Equally, it is difficult to see how a robust business case could be made to hospital managers to support the recommended treatment plan.
Although it is clearly undesirable for patients to have to wait 5 months for an interval operation, with the associated risks of suffering from further symptomatic episodes, there are alternatives to remaining an in-patient for surgery on an emergency list. For example, these patients can be discharged home once their symptoms have settled, with a date for a laparoscopic cholecystectomy within a month, on a dedicated (potentially day-case) ‘hot gallbladder’ list.
COMMENT ON doi 10.1308/003588408X301037 HA Anwar, QA Ahmed, HA Bradpiece. Removing symptomatic gallstones at their first emergency presentation. Ann R Coll Surg Engl 2008; 90: 394–7