Improved Management of Acute Gallstone Disease After Regional Surgical Subspecialization

Abstract

Early laparoscopic cholecystectomy during emergency admission is cost-effective and should be regarded as the standard of care. However, it requires appropriately trained surgeons and availability of a dedicated emergency room, which at present are not consistently provided in all regions of the UK.

Subspecialist emergency management of diverticulitis is associated with reduced mortality and fewer stomas

“…In recognition of these data, general surgical specialities in the Lothian region were reconfigured in July 2002 to provide 24‐h subspecialist care for upper and lower gastrointestinal emergencies by separate teams on separate sites. Previous data from our region demonstrated the benefits of subspecialist management in other aspects of emergency surgical care [19,20]. The aim of this study was to determine the effect of subspecialist colorectal emergency care on the outcome of emergency admission with diverticular disease by comparing results before (January 1998 to July 2002) and after (August 2002 to December 2008) subspecialist reconfiguration, when all colorectal emergencies in the Lothian region were admitted to this new single centre.…”

Success of elective cholecystectomy treatment plans after emergency department visit

“…8,12,13 Reasons for delay in patients with acute cholecystitis were often operating room capacity and a clinical pathway preferring a ‘cooling off’ period. To our knowledge, this is the first study to report the frequency of failure after early laparoscopic cholecystectomy and to describe the population at risk from a large data set.…”

Economic Implications of Providing Emergency Cholecystectomy for All Patients With Biliary Pathology

“…12,[21][22][23] There is little doubt that once such a programme of ALC is well established, surgical trainees will acquire sufficient experience to undertake the ALCs safely with minimal supervision, 23 however, in its early stages considerable consultant-led support will be required. 24 If ALC were to be offered to all patients suitable for surgery, an estimated 2 to 3 cholecystectomies per day could be expected.…”