Adenipekun Ayokunle, Shalaby Amr Ibrahim
Surgery, Health Education England, Birmingham, GBR.
General Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR.
Cureus. 2023 Dec 9;15(12):e50250. doi: 10.7759/cureus.50250. eCollection 2023 Dec.
Introduction Acute gallstone diseases are common surgical emergencies, accounting for approximately one-third of emergency surgical admissions. Laparoscopic cholecystectomy is the standard choice of treatment for gallstone diseases and is currently one of the most commonly performed surgical procedures in the United Kingdom. Majority of these procedures are carried out as elective cases. National Institute of Clinical Excellence (NICE) guidelines and other upper gastrointestinal surgery specialty bodies encourage early emergency surgery in acute symptomatic gallstone disease. We assessed emergency laparoscopic cholecystectomies performed at Birmingham Heartlands Hospital, United Kingdom and compared the practice against NICE and British Benign Upper Gastrointestinal Surgery Society (BBUGSS) recommendations. Methods This is a snapshot retrospective audit, assessing emergency laparoscopic cholecystectomy practice over a nine-month period from November 2022 to July 2023. Variables assessed were demographics, duration of symptoms prior to surgery, imaging modality, indications, C-reactive protein (CRP) levels, operative difficulty, intraoperative and postoperative complications, length of hospital stay and readmission rates. These variables were compared against both NICE and BBUGSS standards. We aimed to establish baseline data to encourage emergency laparoscopic cholecystectomies in our hospital and reduce repeated hospital visits for patients with acute gallbladder disease. Results Forty-eight patients had emergency laparoscopic cholecystectomy in the period reviewed, mean age was 44.3 years and females accounted for approximately 71% (n=34) of the group. 66.7% (n=32) of patients had their surgery within seven days of diagnosis with acute gallstone disease; 50% (n=24) of patients had no adverse intraoperative event. No patient had biliary tract injury despite a high number of difficult cases. Overall there was no correlation between duration before surgery and intraoperative difficulty or readmission rates.
引言 急性胆结石疾病是常见的外科急症，约占急诊外科入院病例的三分之一。腹腔镜胆囊切除术是胆结石疾病的标准治疗选择，目前是英国最常开展的外科手术之一。这些手术大多作为择期病例进行。国家临床优化研究所（NICE）指南及其他上消化道外科专业机构鼓励对急性症状性胆结石疾病尽早进行急诊手术。我们评估了在英国伯明翰心脏地带医院进行的急诊腹腔镜胆囊切除术，并将实际情况与NICE和英国良性上消化道外科学会（BBUGSS）的建议进行了比较。方法 这是一项即时回顾性审计，评估了2022年11月至2023年7月这九个月期间的急诊腹腔镜胆囊切除术实际情况。评估的变量包括人口统计学特征、手术前症状持续时间、成像方式、适应症、C反应蛋白（CRP）水平、手术难度、术中及术后并发症、住院时间和再入院率。将这些变量与NICE和BBUGSS的标准进行了比较。我们旨在建立基线数据，以鼓励我院开展急诊腹腔镜胆囊切除术，并减少急性胆囊疾病患者的再次住院就诊情况。结果 在审查期间，有48例患者接受了急诊腹腔镜胆囊切除术，平均年龄为44.3岁，女性约占该组的71%（n = 34）。66.7%（n = 32）的患者在诊断为急性胆结石疾病后的七天内接受了手术；50%（n = 24）的患者术中无不良事件。尽管有大量困难病例，但没有患者发生胆道损伤。总体而言，手术前持续时间与术中难度或再入院率之间没有相关性。
