Emergency Laparoscopic Cholecystectomy Research Articles

Pre-Operative Group and Save in Elective and Emergency Laparoscopic Cholecystectomy: Necessity, Cost-Effectiveness, and Own Experience.

Background: Laparoscopic cholecystectomy is associated with a high safety profile. This study seeks to quantify the incidence of blood transfusion in both the elective and emergency settings, examine related patient outcomes, and investigate selection criteria for pre-operative Group and Save (G&S) sampling. Methods: A prospective multi-centre observational study was conducted to investigate patients undergoing either elective or emergency laparoscopic cholecystectomy in the UK between January 2020 and May 2021. Multivariate logistical regression models were used to identify patient factors associated with the risk of transfusion and explore outcomes linked to pre-operative G&S sampling. Results: This study comprised 959 patients, with 631 (65.8%) undergoing elective cholecystectomy and 328 (34.2%) undergoing emergency surgery. The median age was 48 years (range: 35-59), with 724 (75.5%) of the patients being female. Only five patients (0.5%) required blood transfusions, receiving an average of three units, with the first unit administered approximately six hours post-operatively. Among these cases, three patients (60%) had underlying haematological conditions. In adjusted models, male gender was significantly associated with the need for a blood transfusion (OR 11.31, p = 0.013), while the presence of a pre-operative Group and Save sample did not demonstrate any positive impact on patient outcomes. Conclusions: The incidence of blood transfusion following laparoscopic cholecystectomy is very low. Male gender and haematological conditions may present as independent risk factors. Pre-operative G&S sampling did not yield any positive impact on patient outcomes and could be safely excluded in both elective and emergency cases, although certain population subsets will warrant further consideration.

INDURG TRIAL Protocol: A Randomized Controlled Trial Using Indocyanine Green during Cholecystectomy in Acute Cholecystitis.

Laparoscopic cholecystectomy is one of the most common gastrointestinal surgeries, and bile duct injury is one of its main complications. The use of real-time indocyanine green fluorescence cholangiography allows the identification of extrahepatic biliary structures, facilitating the procedure and reducing the risk of bile duct lesions. A better visualization of the bile duct may help to reduce the need for conversion to open surgery, and may also shorten operating time. The main objective of this study was to determine whether the use of indocyanine green is associated with a reduction in operating time in emergency cholecystectomies. Secondary outcomes are the postoperative hospital stay, the correct intraoperative visualization of the Calot's Triangle structures with the administration of indocyanine green, and the intraoperative complications, postoperative complications and morbidity according to the Clavien-Dindo classification. This is a randomized, prospective, controlled, multicenter trial with patients diagnosed with acute cholecystitis requiring emergency cholecystectomy. The control group will comprise 220 patients undergoing emergency laparoscopic cholecystectomy applying the standard technique. The intervention group will comprise 220 patients also undergoing emergency laparoscopic cholecystectomy for acute cholecystitis with prior administration of indocyanine green. Due to the lack of published studies on ICG in emergency laparoscopic cholecystectomy, this study may help to establish procedures for its use in the emergency setting.

New Proposed Classification of Difficulty in Laparoscopic Cholecystectomy.

Background: Difficult laparoscopic cholecystectomy (LC) has been challenging for surgeons. Randhawa's system used operative time, complications, and conversion to define three difficulty grades. However, using fixed numbers of operative time as dividers among three groups might not be applicable universally. This study aimed to propose new classification with more flexible parameters. Methods: This retrospective cohort study was conducted with patients who underwent LC because of gallstone-related diseases between January 2017 and December 2021 at Thammasat University Hospital. The exclusion criteria were (1) emergent LC for acute cholecystitis, (2) other procedures performed in the same setting of LC, (3) incomplete information, and (4) LC converted to open cholecystectomy. Patients were categorized into three groups using Randhawa's classification. Thereafter, new classification using mean and standard deviation was applied to reclassify patients into three new groups. The comparison between two grading results was performed to prove the advantage of new classification. Results: Total of 523 patients who underwent LC were included with median age 59.3 years old and 60.8% female. By Randhawa classification, proportions of easy, difficult, and very difficult groups were 39%, 53.7%, and 7.3%, respectively. Then, the new operative-time dividers among three groups were changed from 60 and 120 minutes to mean and mean + 2SD, respectively. Reclassified three difficult groups were 38.9%, 57.1%, and 4%. The comparison demonstrated new classification as more flexible and more compatible with each individual surgeon. Conclusions: New surgeon-referenced grading system of difficult LC included surgeon's factors, not only unfavorable operative findings. This classification should be more flexible than the previous criterion-referenced one. Thai Clinical Trials Registry at https://www.thaiclinicaltrials.org with Number TCTR20220426003.

Never Too Late to Go Home: Declining Same-Day Discharge Rates Throughout the Day After Emergent Laparoscopic Cholecystectomy.

Never Too Late to Go Home: Declining Same-Day Discharge Rates Throughout the Day After Emergent Laparoscopic Cholecystectomy.

Optimizing the consent process for emergent laparoscopic cholecystectomy using an interactive digital education platform: a randomized control trial.

Informed consent is essential for any surgery. The use of digital education platforms (DEPs) can enhance patient understanding of the consent discussion and is a method to standardize the consent process in elective, ambulatory settings. The use of DEP as an adjunct to standard verbal consent (SVC) has not been studied in an acute care setting. We conducted a prospective randomized control trial with patients presenting to the emergency department of a tertiary care hospital with acute biliary pathology requiring a laparoscopic cholecystectomy (LC) between August 2021 and April 2023. Participants were randomized 1:1 to receive either a DEP module with SVC or SVC alone. Baseline procedure-specific knowledge and self-reported understanding of risks and benefits of LC were collected using a questionnaire. Primary outcome was immediate post-intervention knowledge assessed using a 21-question multiple choice questionnaire. Secondary outcomes were delayed procedure-specific knowledge and participants' satisfaction with the consent discussion. We recruited 79 participants and randomized them 1:1 into the intervention group (DEP + SVC, n = 40) and the control group (SVC, n = 39). Baseline demographics and baseline procedure-specific knowledge were similar between groups. The immediate post-intervention knowledge was significantly higher for participants in the intervention versus the control group with a Cohen's d effect size of 0.68 (85.2(10.6)% vs. 78.2(9.9)%; p = 0.004). Similarly, self-reported understanding of risks and benefits of LC was significantly greater for participants in the intervention versus the control group with a Cohen's effect size of 0.76 (68.5(16.4)% vs. 55.1(18.8)%; p = 0.001). For participants who completed the delayed post-intervention assessment (n = 29), there continued to be significantly higher retention of acquired knowledge in the intervention group with a Cohen's effect size of 0.61 (86.5(8.5)% vs. 79.8 (13.1)%; p = 0.024). There was no difference in participants' self-reported satisfaction with the consent discussion between groups (69.5(6.7)% vs. 67.2(7.7)%; p = 0.149). The addition of digital education platform to standard verbal consent significantly improves patient's early and delayed understanding of risks and benefits of LC in an acute care setting.

Repair of umbilical hernias concomitant to other procedures is safe: a propensity score-matched database study.

Repair of an umbilical hernia is most often considered the less important condition when concomitant with other abdominal surgery. Despite this, the evidence for a concomitant umbilical hernia repair is sparse. The aim of this nationwide cohort study is to compare the short- and long-term outcomes of primary umbilical hernia repair and umbilical hernia repair concomitant with other abdominal surgery. Data from the Danish Hernia Database and the National Patients Registry from January 2007 to December 2018 was merged, resulting in identification of patients receiving umbilical hernia concomitant to another abdominal surgery (laparoscopic inguinal hernia repair, laparoscopic cholecystectomy, and laparoscopic appendectomy). This group was propensity score matched with patients undergoing umbilical hernia repair as a primary procedure. Outcome data included 90-day readmission, 90-day reoperation, and operation for recurrence. A total of 3365 primary umbilical hernia repairs and 2418 umbilical hernia repairs concomitant to other abdominal surgery were included. Readmission (10.5%, 255/2418) and reoperation (3.8%, 93/2418) rates within 90 days were decreased for umbilical hernia repairs concomitant to other abdominal surgery, compared with primary umbilical hernia repairs (22.7%, 765/3365) and (10.5%, 255/3365), P<0.001 and P<0.001, respectively. The rate of operation for recurrence was significantly increased for primary repairs (4.2%, 141/3365), compared with repairs concomitant to other abdominal surgery (3.2%, 77/2418), P=0.014. Outcome in umbilical hernia repair performed concomitant to laparoscopic inguinal hernia repair, elective or emergency laparoscopic cholecystectomy, or laparoscopic appendectomy is comparable to umbilical hernia repair without concomitant surgery.

Prognostic factors and predictive models in hot gallbladder surgery: A prospective observational study in a high-volume center.

The standard treatment for acute cholecystitis, biliary pancreatitis and intractable biliary colics ("hot gallbladder") is emergency laparoscopic cholecystectomy (LC). This paper aims to identify the prognostic factors and create statistical models to predict the outcomes of emergency LC for "hot gallbladder." A prospective observational cohort study was conducted on 466 patients having an emergency LC in 17 months. Primary endpoint was "suboptimal treatment," defined as the use of escape strategies due to the impossibility to complete the LC. Secondary endpoints were postoperative morbidity and length of postoperative stay. About 10% of patients had a "suboptimal treatment" predicted by age and low albumin. Postop morbidity was 17.2%, predicted by age, admission day, and male sex. Postoperative length of stay was correlated to age, low albumin, and delayed surgery. Several predictive prognostic factors were found to be related to poor emergency LC outcomes. These can be useful in the decision-making process and to inform patients of risks and benefits of an emergency vs. delayed LC for hot gallbladder.

Evaluating the predictive value of NSQIP surgical risk calculator in patients undergoing emergency laparoscopic cholecystectomy at a single UK centre

Evaluating the predictive value of NSQIP surgical risk calculator in patients undergoing emergency laparoscopic cholecystectomy at a single UK centre

Audit of Emergency Laparoscopic Cholecystectomy in a District General Hospital.

Introduction Acute gallstone diseases are common surgical emergencies, accounting for approximately one-third of emergency surgical admissions. Laparoscopic cholecystectomy is thestandard 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 inacute symptomatic gallstone disease. Weassessed emergency laparoscopic cholecystectomiesperformed at Birmingham Heartlands Hospital, United Kingdom andcompared 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 periodfrom 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 diagnosiswith 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.

Nasopharyngeal malignant melanoma masquerading in the gallbladder: the importance of histological assessment.

Metastatic melanoma of the gallbladder is a rare entity that is often diagnosed late, leading to a poor prognosis. The disease may present insidiously as acute cholecystitis or remain asymptomatic. Optimal management remains unclear but surgical resection is considered the mainstay of treatment for this condition. We report the case of a 47-year-old man who suffered a protracted course of generalised abdominal symptoms eventually culminating in a diagnosis of acute cholecystitis. Following an emergency laparoscopic cholecystectomy, the histology revealed a melanoma with an unknown primary. Subsequently this was traced to the nasopharynx. Because of the presence of concurrent liver metastasis, systemic immunotherapy with palliative intent was commenced following a multidisciplinary team discussion. This case highlights the importance of sending clinical specimens for histological analysis. We argue against selectively choosing which specimens to send for histology because radiological and/or intraoperative macroscopic inspection of resected tissue alone can result in a missed diagnosis.

OGBN P07 Is Emergency Cholecystectomy safe in the oldest old? A 10-year, single institution Retrospective study

Abstract Background The incidence and severity of presentation of cholelithiasis or its complications increases with increasing age. Higher risks of morbidity, longer hospital stay, and mortality are the potential challenges to this emergency procedure in this cohort. There is little UK based data citing outcomes of emergency surgery in this group of population. The aim of this study was to evaluate the safety of emergency cholecystectomy in patients aged 75 and above. Methods Data of consecutive patients aged 75+ undergoing an emergency laparoscopic cholecystectomy for acute cholecystitis at a London district general hospital between January 2013 and April 2023 was analysed. Outcomes of interest were time to procedure, length of hospital-stay, nature of complications and post-operative mortality. Results 123 patients were included. Median age was 80 years (Range 75-93). Median time from presentation to surgery was 4 days (Range 1-45), overall length of stay was 10 days (Range 1-62), and post-procedure stay was 6 days (Range 1-62). Conversion rate was 5% (n=6), overall complication rate was 11% (n=14) and, 4% (n=5) Clavien-Dindo grade 3-4 complications were observed. Bile leak was observed in 2 patients needing ERCP and re-admission rates were 8% (n=10). One patient died within 90 days postoperatively for reasons unrelated to the surgery. Conclusions This study shows that an emergency laparoscopic cholecystectomy has acceptable complication and readmission rates, and it should be considered even in the elderly population. Biologic age rather than demographic age influences the perioperative risks and decision for surgery should be multidisciplinary with risks and benefits carefully weighed with the patient case by case.

EGS P05 Evaluating the predictive value of NSQIP surgical risk calculator in patients undergoing emergency laparoscopic cholecystectomy at a single UK centre

Abstract Background Machine learning algorithms for surgical risk predictions have been utilised as an informed consent tool for surgeons and patients. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) is a surgical risk calculator utilising machine learning to predict adverse postoperative outcomes with surgeon adjustment of risk. However, there is a paucity of validation studies for laparoscopic cholecystectomy data. This study aimed to evaluate the predictive value of the NSQIP calculator in patients undergoing emergency laparoscopic cholecystectomy at a single UK-based centre. Methods Preoperative patient characteristics and postoperative outcome data was collected from patients who underwent emergency laparoscopic cholecystectomy between January 2022 and January 2023. NSQIP surgical risk scores were retrospectively calculated using preoperative characteristics and risk factor data. Surgeon adjustment of risk was set at the default for all patients. The predicted rates of postoperative complications, serious complications (definition as per the NSQIP calculator), and hospital readmission were compared to the observed rates using Brier scores. Results Eighty-five patients were analysed. The median age was 50 (range 19-91) and BMI was 29 (range 21-44). The NSQIP predicted an overall complication rate of 4.2%. Overall observed complication rate was 3.7% and included hospital-acquired pneumonia (n=1), pancreatitis (n=1), and postoperative atrial fibrillation (n=1). The predicted and observed complication rates were comparable (4.2% vs 3.7% respectively, Brier score 0.066). Likewise, the observed rate was also lower than predicted rate for serious complications (2.4% vs. 3.4% respectively, Brier score 0.047). The observed rate of hospital readmission was similar to predicted risk (3.7% vs. 4.0% respectively, Brier score 0.033). Conclusions In this cohort, the NSQIP surgical risk calculator demonstrated acceptable predictive ability for the risk of postoperative complications after emergency laparoscopic cholecystectomy. There was a propensity of the NSQIP calculator to overestimate the risk of complications, within the limitations of the small sample size and retrospective nature of this study. Further studies are warranted to assess the ability of the NSQIP tool to predict the risk of surgery-specific complications.

OGBN P27 Outcome of specialist-led urgent laparoscopic cholecystectomy for gallstone disease at a London District General Hospital

Abstract Background Laparoscopic cholecystectomy is the mainstay for treatment of symptomatic gallstones and its associated complications. Emergency cholecystectomy rates in the United Kingdom (UK) remain low despite NICE guidelines recommendations to offer surgery within 7 days for acute cholecystitis and index cholecystectomy for mild gallstone pancreatitis. We analysed our data over last 10 years to assess the safety and feasibility of providing an emergency cholecystectomy service in a London District general Hospital with a specialist Upper Gastrointestinal / hepatobiliary consultant workforce in line with NICE guidelines. Methods Data of 663 consecutive patients undergoing index admission emergency cholecystectomy during 2013-2023 from a prospectively maintained database was reviewed. Patient demographics, duration of hospital stay, complications, need for further interventions and re-admission rates were collected and analysed. Results Six hundred and sixty-three consecutive patients underwent emergency cholecystectomy gallstone disease and associated complications. The conversion rate was 5.2% (n=35). The median time from presentation to surgery was 2 days (Range 0-63), overall length of stay was 6 days (Range 1-91), and post-procedure stay was 2 days (Range 1-89). Overall complication rate was 7% (n=45), bile leak was observed in 8 patients (1.2%) with no evidence of major biliary injury. One patient had postoperative haemorrhage requiring laparotomy (No bleeder identified) (grade IVa) and 1 patient died within 90 days for reasons unrelated to the operation. The re-admission rate was 10.2%. Conclusions Index admission emergency laparoscopic cholecystectomy in district general hospitals is feasible and safe when performed by a specialist consultant workforce, leading to compliance to guidelines and a low rate of complications and readmissions to hospital.

Operative timing and the safety of emergency laparoscopic cholecystectomy: A retrospective analysis.

The ideal operative timing for laparoscopic cholecystectomy (LC) remains controversial, particularly in emergency patients. This study aimed to evaluate the necessity of operative timing for emergency LC. One hundred ninety-four patients who had undergone operative timings were classified into groups of <72h and >72h from the onset of symptoms to the operation. Baseline data, basic disease, operative bleeding, complications, and conversion rates were analyzed by Variance analysis and logistic regression analysis. The total morbidity of postoperative complication was 4.93% and 3.84% (P = .751) in the <72h and >72h groups respectively. The complication and conversion to LC were mainly influenced by age and gallbladder volume (odds ratio [OR] = 1.078, P = .013, and OR = 1.035, P = .031), but not by operative timing (P = .292). The intraoperative blood loss was closely correlated with the gallbladder volume (OR = 1.019, P = .025) by logit regression analysis, and correlation coefficient of R = 0.436, P < .01. Our results suggest that it is not necessary to confine the operative timing of LC to within 72h from the onset of symptoms, and gallbladder volume should be emphasized in the operative timing for emergency LC.

Preoperative antibiotic prophylaxis in acute cholecystectomy: a systematic review and meta-analysis of randomised controlled trials.

Laparoscopic cholecystectomy (LC) in patients admitted with acute cholecystitis is considered the preferred, feasible and safe mode of managing gallstone disease. The objective of this study is to evaluate the role of single-dose pre-operative prophylactic antibiotics in patients undergoing emergency LC for mild to moderate acute cholecystitis. All randomized control trials (RCTs) reporting the use of single-dose pre-operative prophylactic antibiotics in patients undergoing acute cholecystectomy were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5. Standard medical databases search produced only 3 RCTs on 781 patients undergoing acute cholecystectomy. There were 384 patients in single dose pre-operative antibiotics group whereas 397 patients were recruited in the no-antibiotics group. In the random effects model analysis, the use of single-dose preoperative prophylactic antibiotics in patients undergoing acute cholecystectomy for mild to moderate cholecystitis failed to demonstrate any extra advantage of reducing the risk of [risk ratio (RR) =0.69; 95% confidence interval (CI): 0.46-1.03; Z=1.80; P=0.07] infective complications. There was no heterogeneity [Tau2 =0; Chi2 =1.74, df =2 (P=0.42; I2=0%)] among included studies. A preoperative single dose of prophylactic antibiotics in patients undergoing acute LC for mild to moderate acute cholecystitis does not offer extra benefits to reduce infective complications.

330 Use of Percutaneous Cholecystostomy - Mission Creep or a Genuine Bridge to Surgery?

Abstract Aim Appropriately used, percutaneous cholecystostomy (PC) can be lifesaving. We have noted an increase their use. This may be due to an increasing population frailty combined with delayed presentations or treatment from the COVID pandemic. We sought to audit the use of PC in our Trust. Method Retrospective analysis of prospectively collected data from 2020-2022 at a large DGH with comparison to PC insertion standards (failed antibiotic response &amp; not fit for surgery, septic/too unstable or PC as definitive treatment). Results PC performed 67 times in 64 patients (F = 36.5%. mean age 72 (45-92yrs)). 31 (48.4%) were definitive treatment. 36 (53.7%) were not definitive, 19 subsequently underwent surgery (5 as readmissions, 12 elective &amp; 2 same admission). 25 patients did not meet criteria for PC and potentially could have been considered for emergency laparoscopic cholecystectomy. 35.8% (n = 24) had a DNACPR in place at the time of drain insertion. 25.4% (n = 17) had died at the time of analysis. In the same timeframe n = 168 emergency laparoscopic cholecystectomies were completed. Conclusions PC is an effective treatment strategy but our data suggest that some patients may have been suitable for operative intervention, indicative of “mission creep”. However, the reasons for this are unclear, but may include availability of hot list slots, presentations before a weekend where subspecialty UGI surgeons may not be at hand or a genuine belief that PC is a beneficial bridge to surgery. The wider role of PC requires further evaluation, especially if subspecialty cover is not available.

1211 Review of the Factors Leading to an Unplanned Inpatient Stay Following a Day Case Laparoscopic Cholecystectomy in a Tertiary Centre

Abstract Aim To review the factors responsible for an unplanned Inpatient Stay (IPS) following a day case Laparoscopic Cholecystectomy (LC). To develop strategies preventing unnecessary hospital stays after Day Case LC. Method We retrospectively collected data on all the LC performed in a Tertiary Centre over 3 months (January – March 2022). Results 162 patients underwent LC during this period; 135 (83.3%) patients were planned day cases out of which 68/135 (50.37%) had an IPS and 67/135 (49.62%) were same-day discharges (SDD). 27/162 (16.66%) patients had emergency LC. 54% n = 37 LC performed in the afternoon had IPS compared to 14% n = 10 among the SDD [p&amp;lt;0.0001]. 47% n = 32 In-patient LC performed by non-consultant grade compared to 32% n = 22 among the SDD. 7% n = 5 IP due to social issues, 10% n = 7 no documented IP causes identified and 4% n = 3 had booking error, booked as Inpatient despite the patient having SDD. Other identified causes were drain Insertion (9% n = 6), longer operations (n = 1; mean operation time 92 min IP vs 82 min SDD) and late recovery (9% n = 6). Conclusions The rate of an unplanned overnight stay was found to be significantly high (50.37%, n = 135). Several human factors such as errors in the booking proforma, late-afternoon lists, and no clear discharge planning in the post-op notes were among the few factors which could easily be improved. A review of these factors is deemed necessary not only for improving patient outcomes &amp; quality of care but equally for reducing healthcare costs.

1162 Management of Acute Gallstone Disease at an Urban Acute Trust During the Pandemic – Closed-Loop Audit

Abstract Aim Acute gallstone disease is a surgical emergency with emphasis on early surgery (Laparoscopic Cholecystectomy (LC)) to improve outcomes. Method Patients presenting with acute cholecystitis, biliary colic, and gallstone pancreatitis between September and December 2021 were retrospectively audited. We measured re-admission rates, emergency and elective cholecystectomies performed, and interval between operation and initial admission. This revealed a need for improvement in the service provided at this trust. An intervention was implemented with the Hot Cholecystectomy list being available for other surgeons as well as encouraging acute LC on the Emergency theatre list. A follow-up retrospective audit was carried out between July and September 2022 using the same criteria as per the initial data collection. Results 240 patients were admitted with acute gallstone disease during the initial audit period. At the end of audit period, 49 patients underwent LC, of which only 20% were performed acutely. However, 70% of acute operations were performed during re-admissions. During the re-audit, 109 patients were admitted with acute gallstone disease. Within the three months, 21% of patients underwent LC, out of which 52% were acute operations. 50% of the emergency operations were in re-admission patients. Patients from the initial audit were followed up which revealed average waiting time of 118.5 days from admission to LC Conclusions There was almost a 3-fold increase in the rate of Emergency LC post intervention. While there is an increase, provision of emergency cholecystectomies does not comply with national guidelines. Resources need to be allocated nationwide for timely treatment of acute gallstone disease.

FTP6.13 Do prophylactic antibiotics on general anaesthetic induction improve surgical site and intra-abdominal infection post emergency laparoscopic cholecystectomy?

Abstract Background The role of prophylactic antibiotics in reducing surgical site infection (SSI) and intra-abdominal infection rates in emergency laparoscopic cholecystectomy remains controversial. New antimicrobial Trust guidelines at our unit introduced in May 2022 stated that all emergency “hot” laparoscopic cholecystectomies should receive single dose of IV antibiotics on general anaesthetic induction. We aim to assess whether SSI and intra-abdominal infection rates have improved since introducing these new guidelines. Methods Retrospective study comparing SSI and intra-abdominal infection rates within 30 days of all emergency laparoscopic cholecystectomy cases between February and April 2022 (before new guidelines), to those between August to October 2022 (post new guidelines). Results Total of 56 emergency “hot” laparoscopic cholecystectomy cases prior to, and 44 cases after introduction of new guidelines. 91% cases received IV antibiotics on induction post new guidelines, compared to 35% prior to new guidelines (P=0.038). Proportion of patients who continued with antibiotics post-surgery between 2 cohorts was not statistically significant (P=0.69). There was no statistically significant improvement in overall SSI rates post introduction of new guidelines (P=0.61). Skin closure method (P=0.044) and operating time (P=0.031) were statistically significant in contributing to SSI. There was further no statistically significant difference in rate of intra-abdominal infection post introduction of new guidelines (P=0.83). Conclusion Prophylactic antibiotics at induction do not appear to improve either SSI or intra-abdominal infection rates post emergency lap cholecystectomy cases. Further evaluation is needed over a longer study period, however, in order to ascertain whether these guidelines should be altered for future practise.

ThTP1.1 Follow-Up of Young Patients Undergoing ERCP for Common Bile Duct Stones: Moving Algorithm Towards Surgery

Abstract Background Historically, the default treatment for common bile duct (CBD) stones in our institution has been endoscopic retrograde cholangiopancreatography (ERCP). We aimed to assess the clinical outcomes following ERCP performed for CBD stones in patients aged 35 years old and younger, who may have been suitable for single-stage cholecystectomy with CBD exploration instead. Methods A database of all patients undergoing ERCP from May 2015 to May 2022 in a tertiary institution was prospectively maintained. We identified patients aged 35 and under who received ERCP for CBD stones, and reviewed data on their demographics and clinical outcomes from electronic clinical records. Results A total of 4079 ERCPs were carried out with a post-ERCP pancreatitis rate of 4.3%. 124 patients aged 35 and under (mean age 29±4 years, 84.7% female) were selected for further analysis. They had a post-ERCP pancreatitis rate of 12.1%. 100 patients (80.6%) proceeded to definitive surgery, with a median waiting time of 76 days. Of these, 38.0% experienced an unplanned admission resulting in emergency laparoscopic cholecystectomy; a proportion required repeat ERCP and imaging. Consequently, these patients accumulated a total hospital stay of 13±8 days. Conclusions A higher rate of pancreatitis was seen in younger patients and a delay to definitive treatment is described, resulting in unplanned admissions, re-interventions and extra imaging with the associated increased cost. Single-stage cholecystectomy with CBD exploration would reduce complications, unplanned readmissions and cost. It is now our choice of treatment for CBD stones in this group of patients.