Setting up a surgical complex gallstone service in a non-HPB unit.
Mckay, Siobhan Super, Jonathan Marudanayagam, Ravi Daskalakis, Markos Nijjar, Rajwinder Isaac, John Richardson, Martin
Mckay, Siobhan
Super, Jonathan
Marudanayagam, Ravi
Daskalakis, Markos
Nijjar, Rajwinder
Isaac, John
Richardson, Martin
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2022-03-28
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Abstract
Objectives: Complex gallstone disease is associated with a higher risk of complication during laparoscopic cholecystectomy than biliary colic and simple cholecystitis. It is traditionally managed in a hepatopancreaticobiliary (HPB) unit where there is expertise for common bile duct exploration and repair. We developed a mentorship scheme for a busy upper gastro-intestinal (UGI) unit, with support from a specialist HPB unit to treat complex gallstone disease, to reduce the burden on the HPB unit and enable local treatment of patients.
Material and methods: Through the creation of a service level agreement, the specialist HPB unit were commissioned to provide mentorship for two surgeons at a large UGI unit with an interest in providing a complex gallstone service to their local population. Eight sessions of mentored operating were supported, with the provision for additional support if complications occurred.
Results: There were 14 patients included in the mentorship phase of the programme from November 2015 to May 2017. Cholecystectomies were performed on patients with previously complex histories, which included: previous cholecystostomy; CBD stones and multiple ERCPs; suspected choledochoduodenal fistula; suspected cholecystoduodenal fistula; suspected Mirrizzi's syndrome; previous significant intra-abdominal operation; and significant medical co-morbidities. There was one post-operative complication requiring a return to theatre, and one minor wound infection associated with the complex gallstone lists.
Conclusion: We demonstrated a method to reduce the burden on specialist HPB unit for the operative management of complex gallstone disease and safely implement such a service at large UGI unit with an interest in providing a complex gallstone service.
Citation
Mckay S, Super J, Marudanayagam R, Daskalakis M, Nijjar R, Isaac J, Richardson M, Singhal R. Setting up a surgical complex gallstone service in a non-HPB unit. Turk J Surg. 2022 Mar 28;38(1):81-85. doi: 10.47717/turkjsurg.2022.5559
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