A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK.

摘要

BACKGROUND: Recent management guidelines and randomised clinical trials have provided evidence-based guidance to the management of acute biliary pancreatitis and acute cholecystitis. METHODS: A questionnaire was sent to the 1086 members of the Association of Surgeons of Great Britain and Ireland. There were 583 responders (54%). RESULTS: A policy of cholecystectomy during the index admission or within 4 weeks in fit patients recovering from mild acute biliary pancreatitis was adopted by 58% of surgeons, and was significantly associated with an upper gastrointestinal and hepato-pancreato-biliary subspecialty interest and a volume of more than 50 cholecystectomies per annum (OR, 0.43; 95% CI, 0.26-0.72; P = 0.001: and OR, 0.46; 95% CI, 0.29-0.74; P = 0.001, respectively). A policy of urgent cholecystectomy for acute cholecystitis was adopted by 20% of surgeons, and was significantly associated with an upper gastrointestinal/hepato-pancreato-biliary subspecialty interest and the 'routine' adoption of laparoscopic approach to cholecystectomy (OR, 0.34; 95% CI, 0.19-0.60; P < 0.001: and OR, 0.51; 95% CI, 0.3-0.86; P = 0.01, respectively). CONCLUSIONS: The management of cholelithiasis in patients with acute biliary pancreatitis in the UK remains suboptimal. Moreover, only a minority of surgeons offer patients presenting with acute cholecystitis the benefits of early laparoscopic cholecystectomy. The management of acute biliary disease may be improved if these cases were concentrated in the hands of surgeons with upper gastrointestinal/hepato-pancreato-biliary interest and those who perform laparoscopic cholecystectomy regularly.