Background: Laparoscopic cholecystectomy is commonly performed, and several factors increase the

Reoperation is more common after laparoscopic than after open repair of primary but not recurrent inguinal hernia. Surgeons with a low laparoscopic hernia repair caseload have an increased reoperation rate following laparoscopic repair of primary inguinal hernia. The increase in reoperation rate following laparoscopic repair is seen in the first year or two following the initial surgery.

Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics.

INTRODUCTIONThe aim of this study was to investigate whether definitive treatment of gallstone pancreatitis (GSP) by either cholecystectomy or endoscopic sphincterotomy in England conforms with British Society of Gastroenterology (BSG) guidelines and to validate these guidelines.METHODSHospital Episode Statistics data were used to identify patients admitted for the first time with GSP between April 2007 and April 2008. These patients were followed until April 2009 to identify any who underwent definitive treatment or were readmitted with a further bout of GSP as an emergency.RESULTSA total of 5,454 patients were admitted with GSP between April 2007 and April 2008, of whom 1,866 (34.2%) underwent definitive treatment according to BSG guidelines, 1,471 on the index admission. Patients who underwent a cholecystectomy during the index admission were less likely to be readmitted with a further bout of GSP (1.7%) than those who underwent endoscopic sphincterotomy alone (5.3%) or those who did not undergo any form of definitive treatment (13.2%). Of those patients who did not undergo definitive treatment before discharge, 2,239 received definitive treatment following discharge but only 395 (17.6%) of these had this within 2 weeks. Of the 505 patients who did not undergo definitive treatment on the index admission and who were readmitted as an emergency with GSP, 154 (30.5%) were admitted during the 2 weeks immediately following discharge.CONCLUSIONSFollowing an attack of mild GSP, cholecystectomy should be offered to all patients prior to discharge. If patients are not fit for surgery, an endoscopic sphincterotomy should be performed as definitive treatment.

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Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs.

Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

Aim: The study investigated the rate of significant venous thromboembolism (VTE) following colorectal resection during the index admission and over one year following discharge. It identifies risk factors associated with VTE and considers the length of VTE prophylaxis required.Method: All adult patients who underwent colorectal resections in England between April 2007 and March 2008 were identified using Hospital Episode Statistics (HES) data. They were studied during the index admission and followed for a year to identify any patients who were readmitted as an emergency with a diagnosis of deep venous thrombosis (DVT) or pulmonary embolism (PE).Results: 35997 patients underwent colorectal resection during the period of study. The VTE rate was 2.3%. Two hundred and one (0.56%) patients developed VTE during the index admission and 571 (1.72%) were readmitted with VTE. Following discharge from the index admission, the risk of VTE in patients with cancer remained elevated for six months compared with two months in patients with benign disease. Age, postoperative stay, cancer, emergency admission, and emergency surgery for patients with inflammatory bowel disease (IBD) were all independent risk factors associated with an increased risk of VTE. Patients with ischaemic heart disease and those having elective minimal access surgery (MAS) appear to have lower levels of VTE.Conclusion: This study adds to the benefits of MAS and demonstrates an additional risk to patients undergoing emergency surgery for IBD. The majority of VTE occurs following discharge from the index admission. Therefore, surgery for cancer, emergency surgery for IBD, and those with an extended hospital stay may benefit from extended VTE prophylaxis.This study demonstrates that a stratified approach may be required to reduce the incidence of VTE. Accepted ArticleThis article is protected by copyright. All rights reserved.What does this paper add to the literature?The risk of VTE following colorectal surgery is very well known, but it is not clear from the literature how long the risk persists. This study shows the risk of VTE following discharge remains high for up to 6 months especially in patients having elective surgery for cancer and emergency surgery for IBD