A National Survey of Current Surgical Treatment of Acute Gallstone Disease

Abstract

Acute cholecystitis (AC) and acute pancreatitis are 2 potentially life-threatening complications of gallstone disease. There are national guidelines for the treatment of gallstone pancreatitis, but none exist for the management of AC. Consequently, the management of AC is subject to great variation. To establish the preferred management of uncomplicated AC and adherence to the guidelines for management of mild gallstone pancreatitis among all consultant general surgeons working in Scotland. A national postal survey of all 192 consultant general surgeons in Scotland. One hundred thirty-five responses were received from surgeons, a response rate of 70%. One hundred twenty-six were suitable for further analysis. For uncomplicated AC, 55 (44%) perform urgent laparoscopic cholecystectomy (LC), 29 (23%) perform same admission LC after clinical improvement. Thirty-eight (30%) perform interval LC after discharge. Within this group, 15 surgeons (12% of all replies analyzed) manage AC conservatively at least partly owing to insufficient operating time or equipment when on call. Factors found to increase the likelihood of carrying out same admission LC are undertaking regular laparoscopic work (P<0.001) and having a specialist upper gastrointestinal or vascular interest. In mild gallstone pancreatitis, 74 (58%) perform same admission LC, 21 (17%) would perform sphincterotomy, 3 (2%) would perform one of these, depending on the patient and 5 (4%) would refer to an upper gastrointestinal colleague. Uncomplicated AC and mild gallstone pancreatitis are conditions managed by all subspecialties within general surgery in Scotland. The majority of surgeons (67%) now manage AC by same admission LC, although those not performing regular elective laparoscopy are significantly less likely to do so. Of those who manage conservatively, more than a third report lack of resources as being the reason. For mild gallstone pancreatitis, the majority of surgeons in Scotland (61.5%) perform urgent LC in accordance with current guidelines. A significant proportion of surgeons (17%) carry out endoscopic retrograde cholangiopancreatography as first line in all patients despite this being recommended only for those unfit for surgery.