HPB SO61 - Benefits of Dual-surgeon On-call team on Emergency Laparoscopic Cholecystectomy – a Single Centre Experience

Abstract

Abstract Background Since 2015, UK national guidance from National Institute for Health and Care Excellence (NICE) has been to offer laparoscopic cholecystectomy for patients presenting with acute cholecystitis within 7 days of admission. The aim of this study was to measure the benefits of a second team of surgeons doing emergency operations (first team dealt with emergency admissions and referrals) in terms of length of stay, conversion to open, morbidity, mortality, bile duct injury and rate of early cholecystectomy in a UK based district general hospital. Method Retrospective analysis of a prospectively maintained database was collected from electronic health records, admission and operative notes. Results were extracted in terms of index laparoscopic cholecystectomy, rate of conversion, intra-operative cholangiography, associated morbidity, mortality, bile duct injury, conversion to open, readmission rate and length of stay. The numbers and rates of cholecystectomy over the last six years duration was collected and compared year-on-year period, since early 2019 after the implementation of dual-surgeon on-call cover. Results Altogether, there was 944 cholecystectomy performed within 14 days, out of which 74% of cases was operated within the first week of presentation <8 days since admission. Majority of cholecystectomy was performed laparoscopically, there were twenty-three (2.43%) conversion to open, forty-six sub-total cholecystectomies (4.87%),intraoperative cholangiography was performed in 28.4% of cases and Indocyanine green (ICG) cholangiography was used in 50.5% of all cases. Average length-of-stay (LOS) was 2.2 days, there were eight cases (0.84%) of post-op bile leak, one bile-duct injury, one case of post-operative bleed, one case of small bowel injury and two deaths. Conclusion With the adoption of dual-surgeon on call, early laparoscopic cholecystectomy benefits both patient and hospital. It reduces time to surgery for patients, decreases overall length of stay, and reduces readmission rates and cost, with similar morbidity and mortality.