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

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

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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.

Ann R Coll Surg Engl 2009; 91: 30-34 30Laparoscopic cholecystectomy has become the gold standard for treatment of symptomatic gall stone disease. 1 Recently, this has also gained acceptance as the surgical treatment for acute cholecystitis. The traditional teaching has been a two-stage treatment for acute cholecystitis with an initial conservative management followed by an interval laparoscopic cholecystectomy.2 This has been based on the experience of increased conversion and complication rate with early cholecystectomy in acute cholecystitis which overshadow all the advantages of the laparoscopic approach making this inefficient and unsafe. 3 The conversion rates for elective laparoscopic cholecystectomy range from 3-7%. 4,5 However, in the presence of acute inflammation, higher conversion rates of up to 30% have been reported. 6,7 Timing of surgery in acute cholecystitis has been controversial. Several studies have reported favourable outcomes with a low conversion rate if patients are operated within 96 h of admission. [8][9][10] After that window period, surgeons have opted for interval cholecystectomy after a period of 6-8 weeks. 8Larger surgical centres have published their successful management of acute cholecystitis with urgent laparoscopic cholecystectomy. 11 We set out to discover if similar outcomes were reproducible in a district general hospital. The aim of this study was to determine the conversion rate and the risk of major complications with laparoscopic cholecystectomy for acute cholecystitis and to compare the results with the published data from specialist centres. However, its place remains controversial in the management of acute cholecystitis due to a high reported incidence of bile leaks and conversion rate. Tertiary referral centres have reported good results. We present a series of cases after the introduction of an urgent cholecystectomy pathway in a district general hospital. PATIENTS AND METHODS A practice of urgent cholecystectomy for acute cholecystitis was introduced by three consultant general surgeons. All prospective patients having an urgent laparoscopic cholecystectomy for acute cholecystitis, over an 8-month period were entered into a database. A dedicated ultrasound service was instituted to provide prompt diagnosis in these patients. Their demographic details, operative findings, laboratory results were recorded in a prospective database. Timing of ERCP, postoperative complications and conversion rate and hospital stay were also noted. RESULTS There were 64 patients in the study with a median age of 51 years (range, 21-84 years). There were 21 males and 43 females. All patients underwent laparoscopic cholecystectomy during the index admission. Eleven patients had pre-operative ERCP and 12 patients had on-table cholangiogram. There were no conversions. Postoperative ERCP was required in six patients. The median time interval between admission and operation was 3 days (range, 2-7 days). There were two bile leaks but no common bile duct injury. There were two cases of superfi...

The list of the CholeS management group, Collaborators and Data Validators were omitted from the Acknowledgments.