Early Cholecystectomy in the Ageing Population (2022)

Type of publication:
Conference abstract

*Sturges P.; *Gupta A.; *Rashid U.; *Rupasinghe S.N.; *Adjepong S.; *Parampalli U.; *Kirby G.C.; *Jain R.K.; *Rink J.; *Riera-Portell M.; *Pattar J.

British Journal of Surgery. Conference: ASiT Surgical Conference 2022. Aberdeen United Kingdom. 109(Supplement 6) (pp vi67), 2022. Date of Publication: September 2022.

Background: The age group of patients presenting acutely with biliary pathology is rising and gallstone disease can no longer be said to be a disease of the young. The World Health Organisation classifies those aged 65 and over as elderly. Early cholecystectomy is accepted as a safe and effective method of managing acute biliary pathology, reducing further admissions, and reducing in-hospital stays. Our unit does not use age as barrier but uses performance status and co-morbidity to identify potential candidates for cholecystectomy. Method(s): Patients over the age of 65 who underwent acute cholecystectomy (AC) via the emergency cholecystectomy lists, were audited from 31st December 2019 to 31st June 2021. Patient demographics, co-morbidities and surgical factors were recorded. The primary outcome measures were in-hospital stay and re-admission, secondary outcomes were complications and perioperative mortality. Result(s): 41 elderly patients underwent AC during the audit period, (Female 56%, Male 44%). 30 patients had acute cholecystitis (73%). The median inpatient stay following surgery was 2 days (range 2-5 days) and the median admission to surgery time was 6 days (range 5-12 days). Three patients had a subtotal cholecystectomy. There were 3 complications from surgery which were all between a Clavien-Dindo score of 2 and 3. There were 3 immediate post-operative readmissions, with one 30-day mortality from ERCP pancreatitis and not from the operation. Conclusion(s): Early cholecystectomy appears to be a safe and effective treatment for this group of patients and based on this evidence we should continue to offer this treatment to patients irrespective of age.

Three-dimensional versus two-dimensional imaging during laparoscopic cholecystectomy: a systematic review and meta-analysis of randomised controlled trials (2020)

Type of publication:
Systematic Review

*Davies S.; Ghallab M.; Hajibandeh S.; Hajibandeh S.; Addison S.

Langenbeck's Archives of Surgery; Aug 2020; vol. 405 (no. 5); p. 563-572

Objectives: To evaluate the comparative outcomes of three-dimensional (3D) versus two-dimensional (2D) imaging during laparoscopic cholecystectomy.
Method(s): We conducted a systematic search of electronic information sources and bibliographic reference lists and applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits. Procedure time, Calot's triangle dissection time, gallbladder removal time, gallbladder perforation, intraoperative bleeding, postoperative complications, conversion to open and intraoperative errors were the evaluated outcome parameters.
Result(s): We identified 6 randomised controlled trials (RCT) reporting a total of 577 patients who underwent laparoscopic cholecystectomy using 3D (n = 282) or 2D (n = 295) imaging. The 3D imaging was associated with significantly shorter procedure time (MD – 4.23, 95% CI – 8.14 to – 0.32, p = 0.03), Calot's triangle dissection time (MD – 4.19, 95% CI – 6.52 to – 1.86, p = 0.0004) and significantly lower risk of gallbladder perforation (RR 0.50, 95% CI 0.28-0.88, p = 0.02) compared to the 2D approach. No significant difference was found in gallbladder removal time (MD – 0.79, 95% CI – 2.24 to 0.66, p = 0.28), intraoperative bleeding (RR 1.14, 95% CI 0.68-1.90, p = 0.61), postoperative complications (RD – 0.01, 95% CI – 0.06 to 0.05, p = 0.85), conversion to open (RD 0.00, 95% CI – 0.02 to 0.03, p = 0.70) or intraoperative errors (RR 0.96, 95% CI 0.79-1.17, p = 0.70) between the two groups.
Conclusion(s): Although our findings suggest that the use of 3D imaging during laparoscopic cholecystectomy may be associated with significantly shorter procedure time, Calot's triangle dissection time and gallbladder injury compared to the 2D imaging, the differences seem to be clinically insignificant. Moreover, both approaches carry s similar risk of postoperative morbidities. The impact of the surgeon's level of experience and difficulty of the procedure on the outcomes of each imaging modality remains unknown.

Better safe than total; experience of laparoscopic subtotal cholecystectomy in a specialist Upper GI and Bariatric surgery unit and literature review (2019)

Type of publication:
Conference abstract

*Rehman S.; *Abayomi S.; *Jahangir B.; *Maciejewski M.; *Qassem M. ; *Kirby G.

British Journal of Surgery; Sep 2019; vol. 106, S5; p. 117

Aims: NICE/AUGIS guidelines suggest performing cholecystectomies while 'hot' (within a week). There is a
significant risk of biliary injury and/or open procedure in severely inflamed gallbladders and subtotal
cholecystectomies have been suggested to prevent these. The objective of this article is to present short and
medium term outcomes of laparoscopic subtotal cholecystectomy (LSC) in a specialist upper GI and bariatric
Method(s): This study included all consecutive patients who underwent LSC between August 2014 and August
2018. Clinical notes were retrospectively analysed. Assessed parameters included demographics, urgency of
operation, method of stump closure, length of inpatient stay, biliary injury, post-op incidence of intervention or
re-operation and post-op complications.
Result(s): 20 patients underwent LSC comprising around 0.7% of all the gallbladder operations performed in
our unit during this period. Median age was 67.1 years. 15 (75%) of these operations were carried out as
elective. Stump was closed by absorbable sutures in 18 (90%) of these patients while endoloop was used in one. Median length of stay was 6.2 days. None of the patients had biliary injury on later follow up and 7 (35%)
patients required ERCP. Post-op complications included chronic abdominal pain, wound infection and bile leak
in 2 (10%), 1 (5%) and 1 (5%) patient respectively.
Conclusion(s): Laparoscopic subtotal cholecystectomy proved to have an acceptable profile of safety and
outcomes in our unit and data is comparable with already published literature. Increased incidence of LSC in
elective patients may highlight the significance of establishing a hot gallbladder service.

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