Setting up a surgical complex gallstone service in a non-HPB unit
1Upper GI And Bariatric Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
2Clinic of General Surgery, Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells, United Kingdom
3 Hepato-Pancreato-Biliary (HPB) Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
Objective: 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.
Keywords: Complex gallstone disease, laparoscopic cholecystectomy, mentorship, hepatobiliary surgery
Cite this article as: Mckay S, Super J, Marudanayagam R, Daskalakis M, Nijjar R, Isaac J, et al. Setting up a surgical complex gallstone service in a non-HPB unit. Turk J Surg 2022; 38 (1): 81-85.
The current work was accessed by Medical Research Council (MRC) and Health Research Authority (HRA) tool (http:// www.hra-decisiontools.org.uk/research/question1.html) and was deemed not to be clinical research but instead classified as a clinical audit of outcomes. I can confirm that the current work was registered and approved as an audit at University Hospitals Birmingham NHS Foundation Trust by the Governance/ Ethical committee (CARMS Ref. No: 16827).
Concept - R.S.; Design - R.S., M.R.; Supervision - R.S., R.M.; Materials - R.S., M.D.; Data Collection and/or Processing - S.M.; Analysis and/or Interpretation - S.M., J.S.; Literature Search - S.M., J.I.İ; Writing Manuscript - S.M., J.S.; Critical Reviews - All of authors.
The authors declare that they have no conflict of interest.
The authors declared that this study has received no financial support