Department of Surgery, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Southwick Hill Road, Cosham, Portsmouth, PO6 3LY, UK.
School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.
Surg Endosc. 2023 Feb;37(2):1038-1043. doi: 10.1007/s00464-022-09591-2. Epub 2022 Sep 13.
Despite overwhelming evidence of the clinical and financial benefit of urgent cholecystectomy, there is variable enthusiasm and uptake across the UK. In 2014, following the First National Emergency Laparotomy Audit Organisational Report, we implemented a specialist-led urgent surgery service, whereby all patients with gallstone-related pathologies were admitted under the direct care of specialist upper gastrointestinal surgeons. We have analysed 5 years of data to investigate the results of this service model.
Computerised operating theatre records were interrogated to identify all patients within a 5-year period undergoing cholecystectomy. Patient demographics, admission details, length of stay, duration of surgery, and complications were analysed.
Between 01/01/2016 and 31/12/2020, a total of 4870 cholecystectomies were performed; 1793 (36.8%) were urgent cases and 3077 (63.2%) were elective cases. All cases were started laparoscopically; 25 (0.5%) were converted to open surgery-14 of 1793 (0.78%) urgent cases and 11 of 3077 (0.36%) elective cases. Urgent cholecystectomy took 20 min longer than elective surgery (median 74 versus 52 min). No relevant difference in conversion rate was observed when urgent cholecystectomy was performed within 2 days, between 2 and 4 days, or greater than 4 days from admission (P = 0.197). Median total hospital stay was 4 days.
Urgent laparoscopic cholecystectomy is safe and feasible in most patients with acute gall bladder disease. Surgery under the direct care of upper gastrointestinal specialist surgeons is associated with a low conversion rate, low complication rate, and short hospital stay. Timing of surgery has no effect on conversion rate or complication rate.
尽管有大量证据表明紧急胆囊切除术具有临床和经济效益，但英国各地对此的热情和接受程度存在差异。2014 年，在第一次全国紧急剖腹手术审计组织报告之后，我们实施了由专家领导的紧急手术服务，所有患有胆石相关疾病的患者都在专门的上消化道外科医生的直接护理下住院。我们分析了 5 年的数据，以调查这种服务模式的结果。
通过计算机化的手术室记录来识别 5 年内接受胆囊切除术的所有患者。分析患者的人口统计学、入院详细信息、住院时间、手术持续时间和并发症。
2016 年 1 月 1 日至 2020 年 12 月 31 日，共进行了 4870 例胆囊切除术；其中 1793 例（36.8%）为紧急手术，3077 例（63.2%）为择期手术。所有手术均开始腹腔镜下进行；其中 25 例（0.5%）转为开放性手术-1793 例中的 14 例（0.78%）紧急手术和 3077 例中的 11 例（0.36%）择期手术。紧急胆囊切除术比择期手术长 20 分钟（中位数 74 分钟比 52 分钟）。当紧急胆囊切除术在入院后 2 天内、2 至 4 天内或超过 4 天内进行时，转换率没有明显差异（P=0.197）。中位总住院时间为 4 天。
在大多数患有急性胆囊疾病的患者中，紧急腹腔镜胆囊切除术是安全可行的。在上消化道专家外科医生的直接护理下进行手术，具有较低的转换率、较低的并发症发生率和较短的住院时间。手术时间对转换率或并发症发生率没有影响。
