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. 2008 Oct-Dec;12(4):389-94.

Patient experience with gallstone disease in a national health service district hospital

Santosh Balakrishnan  1 , Tushar Samdani, Tarun Singhal, Abdulzahra Hussain, Starlene Grandy-Smith, Jacqueline Nicholls, Shamsi El-Hasani
Affiliations

Patient experience with gallstone disease in a national health service district hospital

Santosh Balakrishnan et al. JSLS. 2008 Oct-Dec.

Abstract

Background: The prevalence of gallstone disease in the community makes it an important area of service in district general hospitals. Laparoscopic surgical techniques in synergy with modern imaging and endoscopic and interventional techniques have revolutionized the treatment of gallstone disease, making it possible to provide prompt and definitive care to patients.

Methods: Patients with gallstone disease were treated based on a predetermined protocol by a special-interest team depending on the patient's mode of presentation. Data were collected and analyzed prospectively.

Results: Our team treated 1332 patients with gallstone disease between September 1999 and December 2007. Patients (249) with acute symptoms presented through Accident and Emergency (A&E). Despite varied presentations, laparoscopic treatment was possible in all but 8 patients. The study comprised 696 patients who underwent laparoscopic cholecystectomy (LC) as in-hospital (23 hour) cases in a stand-alone center, and 257 outpatients and 379 inpatients. Sixty-seven patients with acute cholecystitis had their surgery within 96 hours of acute presentation. Seventy patients had laparoscopic subtotal cholecystectomy. The overall morbidity was 2.33% with 3 patients having residual common bile duct stones; 3 patients had biliary leak from cystic or accessory duct stumps and one had idiopathic right segmental liver atrophy; 19 had wound infections, 5 had port-site hernia. No mortalities occurred during the 30-day follow-up.

Conclusion: We believe that prompt investigation with imaging and endoscopic intervention if needed along with LC at the earliest safe opportunity by a specialized dedicated team represents an effective method for treating gallstone disease in district general hospitals. Our experience with over 1000 patients has offered us the courage of conviction to say that justice is finally here for gallstone sufferers.

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Figures

Figure 1.
Figure 1.
Mode of presentation of gallstone disease.
Figure 2.
Figure 2.
Mode of delivery of care and admission and discharge pattern for laparoscopic cholecystectomy. A: 684 cases; 12 discharge failures. B: 253 cases; 4 discharge failures. C: 379 cases.
See this image and copyright information in PMC

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