Siobhan Mckay1, Jonathan Super2, Ravi Marudanayagam3, Markos Daskalakis1, Rajwinder Nijjar1, John Isaac3, Martin Richardson1, Rishi Singhal1

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.


Ethics Committee Approval

The current work was accessed by Medical Research Council (MRC) and Health Research Authority (HRA) tool (http:// 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).

Peer Review

Externally peer-reviewed.

Author Contributions

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.

Conflict of Interest

The authors declare that they have no conflict of interest.

Financial Disclosure

The authors declared that this study has received no financial support