Tu1514 Trends in the Management of Acute Cholecystitis: Prevalence of Percutaneous Cholecystostomy and Delayed Cholecystectomy in an Elderly Population

Abstract

BODY: Objectives: To assess the outcome of laparoscopic clearance of common bile duct stones at an advanced laparoscopic unit in South Wales. Method: A prospective database was constructed to capture data on laparoscopic common bile duct clearance cases and included demographics, imaging, indications, technique, ductal access route, success rate, operating time, duration of hospital stay, bile leakage, sub phrenic collection, biliary peritonitis and postoperative jaundice. Results: Sixty (60) consecutive patients who had an attempt at concomitant laparoscopic cholecystectomy and common bile duct clearance populated the database. (7/60) cases were performed following a failed endoscopic clearance. Complete laparoscopic clearance was achieved in (44/60) 73.3% of attempted cases, 11/60 (18.3%) were converted to open (due to impacted stone or other intra operative difficulties) and cleared completely; (6/60) 10% failed laparoscopic clearance and was referred to post operative endoscopic therapy. 5/60 cases were performed following emergency admission and other 55/60 were planned procedures. Trans-cystic approach was utilised in 34/60 (56.6%) and was successful in 27/34(79.4%) but failed in 4/34 (11.7%) and converted to open with successful clearance in 1, the remaining 3/34(8.8%) referred for post operative ERCP. Trans-choledochotomy clearance was used in 26/60 (43.3%) cases and succeeded in 19/26(73.3%) and converted to open in 7/26(26%) with successful clearance in all. A total of 11 cases (18%) failed complete clearance laparoscopically and converted to open and 8 out of the 11 were completely cleared. Ttube was used in 2/26 (7.6%) choledochotomy cases and lead to a longer hospital stay. A Total of 4 (19%) patients had post operative complications, 2 bile leaks, 1 post operative bleed and 1 dislodgment of T -tube. There was no mortality. Conclusion: Laparoscopic common bile duct clearance during cholecystectomy followed by ERCP for failure of ductal clearance is probably the optimal approach. Short term outcome results support the safety and effectiveness of laparoscopic CBD clearance approach; but a careful long term outcome and clinical and biochemical follow up for all patients undergoing such a procedure is required.