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Ann R Coll Surg Engl. 2009 September; 91(6): 537.
PMCID: PMC2966228

Urgent Cholecystectomy for Acute Cholecystitis

Khan et al. have produced a well-structured study which describes the introduction of urgent laparoscopic cholecystectomy for acute cholecystitis in a district general hospital.

A number of randomised trials1,2 have shown that performing early laparoscopic cholecystectomy for acute cholecystitis was better than delayed cholecystectomy; the issue is still, however, surrounded by controversy.

Although operation within the ‘golden 96 hours’ is suggested,3 it is our experience that, in a district general hospital, there are numerous logistic difficulties with regards to the time required for an accurate diagnosis based on the findings of an abdominal ultrasound scan and accommodating such operations on the emergency operating list.

As a result, we would like to ask whether a dedicated fast-track ultrasound service for the confirmation of acute cholecystitis had any impact on the quality and cost-effectiveness with regards to service provision in carrying out other emergency and elective radiological investigation. Also, it would have been interesting to know the rationale for routinely placing a sub-hepatic drain in all cases and how long the drain was left in situ.

References

1. Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, et al. Randomised trial of early versus delayed laparoscopic cholecystectomy of acute cholecystitis. Br J Surg. 1998;85:764–7. [PubMed]
2. Lo CM, Liu CL, Fan ST, Lai ECS, Wong J. Prospective randomised study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998;227:461–7. [PubMed]
3. Koo K, Thirbly R. Laparoscopic cholecystectomy in acute cholecystitis. What is the optimal timing for operation? Arch Surg. 1996;131:540–4. [PubMed]

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