Cholecystectomy for Complicated Gallbladder and Common Biliary Duct Stones: Current Surgical Management

Yanna Argiriov,Christos Tsironis,Melanie Dani,Louis J Koizia

doi:10.3389/fsurg.2020.00042

Yanna Argiriov, Christos Tsironis + Show 2 more

Open Access

https://doi.org/10.3389/fsurg.2020.00042

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Abstract

Gallstone disease accounts for the vast majority of acute surgical admissions in the UK, with a major treatment being cholecystectomy. Practice varies significantly as to whether surgery is performed during the acute symptomatic phase, or after a period of recovery. Differences in practice relate to operative factors, patient factors, surgeon factors and hospital and trust wide policies. In this review we summarize recent evidence on management of gallstone disease, particularly with respect to whether cholecystectomy should occur during index presentation or following recovery. We highlight morbidity and mortality studies, cost, and patient reported outcomes. We speculate on barriers to change in service delivery. Finally, we propose potential solutions to optimize care.

Highlights

AND OBJECTIVESGallstone-related disease was the commonest cause of hospital admissions in the developed world at the beginning of the 21st Century [1, 2]
In this review we summarize recent evidence on management of gallstone disease, with respect to whether cholecystectomy should occur during index presentation or following recovery
In those with high comorbidity scores, poor performance statuses, jaundice, cranial neuropathy, respiratory dysfunction, or organ failure that is not rapidly reversible, percutaneous transhepatic gallbladder drainage (PTGD) followed by delayed cholecystectomy at 6 weeks is preferable with better morbidity outcomes [113,114,115]

Summary

INTRODUCTION

Gallstone-related disease was the commonest cause of hospital admissions in the developed world at the beginning of the 21st Century [1, 2]. It should be noted that early cholecystectomy is not appropriate for all patients, and this is acknowledged in TG18 [113] In those with high comorbidity scores, poor performance statuses, jaundice, cranial neuropathy, respiratory dysfunction, or organ failure that is not rapidly reversible, percutaneous transhepatic gallbladder drainage (PTGD) followed by delayed cholecystectomy at 6 weeks is preferable with better morbidity outcomes [113,114,115]. We recommend that IOC be performed more routinely where appropriate, allowing patients to have cholecystectomy and bile duct analysis as one procedure The benefit of this is threefold: it relieves pressure on MRCP services (which are not always widely available), reduces pre-operative investigatory delays, and can shorten length of stay [46, 119].

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CONCLUSION

47. Quality statement 2