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With regards to the efficacy of fast-track ultrasound service for these patients, our observation was that confirmation of the diagnosis and getting the radiological investigations was one of the major delays in offering these patients emergency cholecystectomy at our hospital. A fast-track, dedicated ultrasound service was set up for this purpose and this was separate from the on-call provision of radiology services. Although we did not carry out a proper cost-effective analysis, it was found that a rapid access to ultrasound service led to quicker decision making and resulted in more patients operated in a timely manner on the emergency list with good quality outcomes.
The acutely inflamed gallbladder poses a more technically demanding dissection with potential for an increase in bile leak rates.1 The risk of bile leak after emergency cholecystectomy has been reported between 2–3%.2 It has been our protocol to leave sub-hepatic drain in all cases having an emergency cholecystectomy. The drains were usually removed at 24 h.