{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T21:46:26Z","timestamp":1770327986592,"version":"3.49.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T00:00:00Z","timestamp":1598572800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T00:00:00Z","timestamp":1598572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000853","name":"University of Glasgow","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000853","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>The rate of acute laparoscopic cholecystectomy remains low due to operational constraints. The purpose of this study is to evaluate a service model of index admission cholecystectomy with referral protocols, refined logistics and targeted job planning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospectively maintained dataset was evaluated to determine the processes of care and outcomes of patients undergoing emergency biliary surgery. The lead author has maintained a 28\u00a0years prospective database capturing standard demographic data, intraoperative details including the difficulty of cholecystectomy as well as postoperative outcome parameters and follow up data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Over five thousand (5555) consecutive laparoscopic cholecystectomies were performed. Only patients undergoing emergency procedures (2399,43.2% of entire group) were analysed for this study. The median age was 52\u00a0years with 70% being female. The majority were admitted with biliary pain (34%), obstructive jaundice (26%) and acute cholecystitis (16%). 63% were referred by other surgeons. 80% underwent surgery within 5\u00a0days (40% within 24\u00a0h). Cholecystectomies were performed on scheduled lists (44%) or dedicated emergency lists (29%). Two thirds had suspected bile duct stones and 38.1% underwent bile duct exploration. The median operating time was 75\u00a0min, median hospital stay 7\u00a0days, conversion rate 0.8%, morbidity 8.9% and mortality rate 0.2%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Index admission cholecystectomy for biliary emergencies can have low rates of morbidity and mortality. Timely referral and flexible theatre lists facilitate the service, optimising clinical results, number of biliary episodes, hospital stay and presentation to resolution intervals. Cost benefits and reduced interval readmissions need to be weighed against the length of hospital stay per episode.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00464-020-07900-1","type":"journal-article","created":{"date-parts":[[2020,8,28]],"date-time":"2020-08-28T16:03:59Z","timestamp":1598630639000},"page":"4192-4199","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Optimising the outcomes of index admission laparoscopic cholecystectomy and bile duct exploration for biliary emergencies: a service model"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7878-7024","authenticated-orcid":false,"given":"Ahmad H. M.","family":"Nassar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hwei J.","family":"Ng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zubir","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arkadiusz Peter","family":"Wysocki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Colin","family":"Wood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayman","family":"Abdellatif","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,8,28]]},"reference":[{"key":"7900_CR1","unstructured":"Hospital Episode Statistics Admitted Patient Care England (2013\u20132014) Health and Social Care Information Centre. https:\/\/www.hscic.gov.uk\/catalogue\/PUB16719. Accessed April 2020"},{"key":"7900_CR2","unstructured":"AUGIS\/ASGBI J (2015) Pathway on management of acute gallstone diseases. https:\/\/www.augis.org\/wp-content\/uploads\/2014\/05\/Acute-Gallstones-Pathway-Final-Sept-2015.pdf. Accessed April 2020"},{"issue":"1","key":"7900_CR3","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1007\/s00464-012-2415-0","volume":"27","author":"S Sinha","year":"2013","unstructured":"Sinha S, Hofman D, Stoker D, Friend P, Poloniecki J, Thompson M et al (2013) Epidemiological study of provision of cholecystectomy in England from 2000 to 2009: retrospective analysis of hospital episode statistics. Surg Endosc 27(1):62\u2013175","journal-title":"Surg Endosc"},{"key":"7900_CR4","doi-asserted-by":"publisher","first-page":"e3330","DOI":"10.1136\/bmj.e3330","volume":"344","author":"E Harrison","year":"2012","unstructured":"Harrison E, O\u2019Neil S, Meurs T, Wong P, Duxbury M, Paterson-Brown S et al (2012) Hospital volume and patient outcomes after cholecystectomy in Scotland: retrospective, national population based study. BMJ 344:e3330","journal-title":"BMJ"},{"key":"7900_CR5","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1136\/pgmj.2002.004085","volume":"80","author":"I Cameron","year":"2004","unstructured":"Cameron I, Chadwick C, Phillips J, Johnson A (2004) Management of acute cholecystitis in UK hospitals: time for a change. Postgrad Med J 80:292\u2013294","journal-title":"Postgrad Med J"},{"key":"7900_CR6","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1007\/s00534-005-1088-7","volume":"13","author":"Y Yamashita","year":"2006","unstructured":"Yamashita Y, Takada T, Hirata K (2006) A survey of the timing and approach to the surgical management of patients with acute cholecystitis in Japanese hospitals. J Hepatobiliary Pancreat Surg 13:409\u2013415","journal-title":"J Hepatobiliary Pancreat Surg"},{"key":"7900_CR7","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1053\/j.gastro.2015.09.002","volume":"150","author":"D Shabanzadeh","year":"2016","unstructured":"Shabanzadeh D, S\u00f8rensen L, J\u00f8rgensen T (2016) A prediction rule for risk stratification of incidentally discovered gallstones: results from a large cohort study. Gastroenterology 150:156\u2013167","journal-title":"Gastroenterology"},{"key":"7900_CR8","unstructured":"NICE. National Institute of Health and Care Excellence (2014) Gallstone disease: diagnosis and initial management. Recommendations. Guidance and guidelines. NICE. Nice.org.uk. https:\/\/www.nice.org.uk\/guidance\/cg188\/chapter\/1-Recommendations#managing-gallbladder-stones. Accessed April 2020"},{"key":"7900_CR9","unstructured":"Gallstone disease commissioning guide (2016) Royal College of Surgeons England. https:\/\/www.rcseng.ac.uk\/-\/media\/files\/rcs\/standards-and-research\/commissioning\/gallstone-disease-commissioning-guide-for-republication.pdf. Accessed April 2020"},{"key":"7900_CR10","unstructured":"Guidelines for the Clinical Application of Laparoscopic Biliary Tract Surgery (2016) SAGES. https:\/\/www.sages.org\/publications\/guidelines\/guidelines-for-the-clinical-application-of-laparoscopic-biliary-tract-surgery. Accessed April 2020"},{"issue":"1","key":"7900_CR11","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1002\/jhbp.516","volume":"25","author":"K Okamoto","year":"2018","unstructured":"Okamoto K, Suzuki K, Takada T, Strasberg S, Asbun H, Endo I et al (2018) Tokyo guidelines 2018: flowchart for the management of acute cholecystitis. J Hepatobiliary Pancreat Sci 25(1):55\u201372","journal-title":"J Hepatobiliary Pancreat Sci"},{"issue":"1","key":"7900_CR12","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1002\/jhbp.509","volume":"25","author":"F Miura","year":"2018","unstructured":"Miura F, Okamoto K, Takada T, Strasberg S, Asbun H, Pitt H et al (2018) Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis. J Hepatobiliary Pancreat Sci 25(1):31\u201340","journal-title":"J Hepatobiliary Pancreat Sci"},{"issue":"4","key":"7900_CR13","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.pan.2013.07.063","volume":"13","author":"Working Group IAP\/APA Acute Pancreatitis Guidelines","year":"2013","unstructured":"Working Group IAP\/APA Acute Pancreatitis Guidelines (2013) IAP\/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 13(4):e1\u2013e15","journal-title":"Pancreatology"},{"key":"7900_CR14","first-page":"iii1","volume":"54","author":"Working Party of the British Society of Gastroenterology, Association of Surgeons of Great Britain and Ireland Pancreatic Society of Great Britain and Ireland, Association of Upper GI Surgeons of Great Britain and Ireland","year":"2005","unstructured":"Working Party of the British Society of Gastroenterology, Association of Surgeons of Great Britain and Ireland Pancreatic Society of Great Britain and Ireland, Association of Upper GI Surgeons of Great Britain and Ireland (2005) UK guidelines for the management of acute pancreatitis. Gut 54:iii1\u2013iii9","journal-title":"Gut"},{"issue":"2","key":"7900_CR15","doi-asserted-by":"publisher","first-page":"63","DOI":"10.3109\/13645709509152757","volume":"4","author":"AHM Nassar","year":"1995","unstructured":"Nassar AHM, Ashkar KA, Mohamed AY, Hafiz AA (1995) Is laparoscopic cholecystectomy possible without video technology? Minim Invasiv Ther Taylor Francis 4(2):63\u201365","journal-title":"Minim Invasiv Ther Taylor Francis"},{"issue":"2","key":"7900_CR16","doi-asserted-by":"publisher","first-page":"e2020.","DOI":"10.4293\/JSLS.2020.00015","volume":"24","author":"HEl Zanati","year":"2020","unstructured":"Zanati HEl, Nassar AHM, Zino S, Katbeh T, Ng HJ, Abdellatif A (2020) Gall bladder empyema: early cholecystectomy during the index admission improves outcomes. JSLS 24(2):e2020.00015","journal-title":"JSLS"},{"key":"7900_CR17","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-020-07765-4","author":"AHM Nassar","year":"2020","unstructured":"Nassar AHM, Nassar MK, Gil IC et al (2020) One-session laparoscopic management of Mirizzi syndrome: feasible and safe in specialist units. Surg Endosc. https:\/\/doi.org\/10.1007\/s00464-020-07765-4","journal-title":"Surg Endosc"},{"issue":"6","key":"7900_CR18","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1007\/s00464-006-9127-2","volume":"21","author":"AH Hamouda","year":"2007","unstructured":"Hamouda AH, Goh W, Mahmud S, Khan M, Nassar AHM (2007) Intraoperative cholangiography facilitates simple transcystic clearance of ductal stones in units without expertise for laparoscopic bile duct surgery. Surg Endosc 21(6):955\u2013959","journal-title":"Surg Endosc"},{"issue":"5","key":"7900_CR19","doi-asserted-by":"publisher","first-page":"1958","DOI":"10.1007\/s00464-015-4421-5","volume":"30","author":"H Qandeel","year":"2016","unstructured":"Qandeel H, Zino S, Hanif Z, Nassar MK, Nassar AHM (2016) Basket-in-catheter access for transcystic laparoscopic bile duct exploration: technique and results. Surg Endosc 30(5):1958\u20131964","journal-title":"Surg Endosc"},{"issue":"11","key":"7900_CR20","doi-asserted-by":"publisher","first-page":"3190","DOI":"10.1007\/s00464-012-2315-3","volume":"26","author":"V Gough","year":"2012","unstructured":"Gough V, Stephens N, Ahmed Z, Nassar AHM (2012) Intrahepatic choledochoscopy during trans-cystic common bile duct exploration; technique, feasibility and value. Surg Endosc 26(11):3190\u20133194","journal-title":"Surg Endosc"},{"issue":"11","key":"7900_CR21","doi-asserted-by":"publisher","first-page":"1302","DOI":"10.1002\/bjs.9886","volume":"102","author":"X Wu","year":"2015","unstructured":"Wu X, Tian X, Liu M, Wu L, Zhao S, Zhao L (2015) Meta-analysis comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 102(11):1302\u20131313","journal-title":"Br J Surg"},{"issue":"12","key":"7900_CR22","doi-asserted-by":"publisher","first-page":"1704","DOI":"10.1002\/bjs.10287","volume":"103","author":"CholeS Study Group WMRC","year":"2016","unstructured":"CholeS Study Group WMRC (2016) Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases. Br J Surg 103(12):1704\u20131715","journal-title":"Br J Surg"},{"key":"7900_CR23","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1007\/s00464-018-6281-2","volume":"33","author":"E Griffiths","year":"2019","unstructured":"Griffiths E, Hodson J, Vohra R, Marriott P, Katbeh T, Zino S et al (2019) Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy. Surg Endosc 33:110\u2013121","journal-title":"Surg Endosc"},{"key":"7900_CR24","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-019-07244-5","author":"AHM Nassar","year":"2019","unstructured":"Nassar AHM, Hodson J, Ng HJ, Vohra RS, Katbeh T, Zino S et al (2019) Predicting the difficult laparoscopic cholecystectomy: development and validation of a preoperative risk score using an objective operative difficulty grading system. Surg Endosc. https:\/\/doi.org\/10.1007\/s00464-019-07244-5","journal-title":"Surg Endosc"},{"issue":"10","key":"7900_CR25","doi-asserted-by":"publisher","first-page":"3275","DOI":"10.1007\/s00464-018-06613-w","volume":"33","author":"L Yunxiao","year":"2019","unstructured":"Yunxiao L, Yunxiao C, Ting L, Bin C, Xin J (2019) Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc 33(10):3275\u20133286","journal-title":"Surg Endosc"},{"key":"7900_CR26","unstructured":"NICE. National Institute of Health and Care Excellence (2014) Costing statement: gallstone disease. Implementing the NICE guideline on gallstone disease (CG188). https:\/\/www.nice.org.uk\/guidance\/cg188\/resources\/costing-statement-pdf-193298365. Accessed April 2020"},{"key":"7900_CR27","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1308\/rcsann.2016.0049","volume":"98","author":"S Bokhari","year":"2016","unstructured":"Bokhari S, Walsh U, Qurashi K, Liasis L, Watfah J, Sen M et al (2016) Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis. Ann R Coll Surg Engl 98:107\u2013115","journal-title":"Ann R Coll Surg Engl"},{"issue":"8","key":"7900_CR28","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1308\/003588409X464478","volume":"91","author":"S Agrawal","year":"2009","unstructured":"Agrawal S, Battula N, Barraclough L, Durkin D, Cheruvu C (2009) Early laparoscopic cholecystectomy service provision is feasible and safe in the current UK National Health Service. Ann R Coll Surg Eng 91(8):660\u2013664","journal-title":"Ann R Coll Surg Eng"},{"key":"7900_CR29","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD007196.pub3","author":"K Gurusamy","year":"2013","unstructured":"Gurusamy K, Koti R, Fusai G, Davidson B (2013) Early versus delayed laparoscopic cholecystectomy for uncomplicated biliary colic. Cochrane Database Syst Rev. https:\/\/doi.org\/10.1002\/14651858.CD007196.pub3","journal-title":"Cochrane Database Syst Rev"},{"issue":"2","key":"7900_CR30","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1002\/bjs.6870","volume":"97","author":"K Gurusamy","year":"2010","unstructured":"Gurusamy K, Samraj K, Gluud C, Wilson E, Davidson B (2010) Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 97(2):141\u2013150","journal-title":"Br J Surg"},{"issue":"1","key":"7900_CR31","doi-asserted-by":"crossref","first-page":"3","DOI":"10.55519\/JAMC-01-9006","volume":"31","author":"S Khan","year":"2019","unstructured":"Khan S, Soh J, Muhibullah N, Peleki A, Abdullah M, Waterland P (2019) Emergency laparoscopic cholecystectomy: is dedicated hot gallbladder list cost effective? J Ayub Med Coll Abbottabad 31(1):3\u20137","journal-title":"J Ayub Med Coll Abbottabad"},{"issue":"10","key":"7900_CR32","doi-asserted-by":"publisher","first-page":"1370","DOI":"10.1007\/s00464-004-2242-z","volume":"19","author":"GE Shallaly","year":"2005","unstructured":"Shallaly GE, Seow C, Sharp C, Mughrabi A, Nasssar AHM (2005) Intraoperative cholangiography time in laparoscopic cholecystectomy: timing the radiographer. Surg Endosc 19(10):1370\u20131372","journal-title":"Surg Endosc"},{"issue":"3","key":"7900_CR33","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1007\/s00464-008-9853-8","volume":"23","author":"AHM Nassar","year":"2009","unstructured":"Nassar AHM, Shallaly GE, Hamouda A (2009) Optimising laparoscopic cholangiography time using a simple cannulation technique. Surg Endosc 23(3):513\u2013517","journal-title":"Surg Endosc"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-020-07900-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-020-07900-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-020-07900-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,10]],"date-time":"2022-11-10T21:24:20Z","timestamp":1668115460000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-020-07900-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,28]]},"references-count":33,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["7900"],"URL":"https:\/\/doi.org\/10.1007\/s00464-020-07900-1","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,28]]},"assertion":[{"value":"5 June 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 August 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 August 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Ahmad H. M. Nassar, Hwei J. Ng, Zubir Ahmed, Arkadiusz Peter Wysocki, Colin Wood and Ayman Abdellatif have no conflicts of interest or financial ties to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}