Readmissions after laparoscopic cholecystectomy in a UK District General Hospital.

INTRODUCTION: Laparoscopic cholecystectomy is the gold standard for the treatment of symptomatic gallstones and its practice as day case where possible is considered the standard over the last decade. However, readmission after surgery is recognised as a new problem. AIM: The aim of this cohort observational study was to investigate the readmission rate in a district general hospital and identify the causes of readmission in order to explore ways by which this can be reduced or managed more cost effectively. METHOD: Records of patients who had laparoscopic cholecystectomy over 6 months were retrospectively searched. Patients returning to hospital due to symptoms within 30 days of elective and emergency laparoscopic cholecystectomy were included. RESULTS: Three hundred and twenty-eight laparoscopic cholecystectomies were performed within the 6-month period. Twenty-two patients returned within 30 days of surgery making a readmission rate of 6.7%. Reasons for inpatient admission were abdominal pain without any underlying cause 10 (45.5%), wound infection 5 (22.7%), leg swelling 2 (9%), retained stone 1 (4.5%), bile leak 1 (4.5%), pneumonia 1 (4.5%), iatrogenic bowel injury 1 (4.5%) and back pain 1 (4.5%). Readmission rate decreased with longer duration of stay in hospital during primary admission, and 64% of patients returned to the hospital within 7 days of procedure. 50% of patients who returned with abdominal pain without any identifiable cause had a longstanding history of conditions involving chronic pain. CONCLUSION: While the feared intra-abdominal complications of cholecystectomy often come to mind when assessing patients presenting with abdominal pain after surgery, non-specific abdominal pain is consistently shown to be several times more likely. A combination of patient factors and pain control techniques account for this pain. Effective multimodal pain management approach and community primary health care support in the early post-operative period could reduce readmission, save cost and improve patient experience.

Endovascular repair of early rupture of Dacron aortic graft--two case reports.

Complications after open aortic surgery pose a challenge both to the vascular surgeon and the patient because of aging population, widespread use of cardiac revascularization, and improved survival after aortic surgery. The perioperative mortality rate for redo elective aortic surgery ranges from 5% to 29% and increases to 70-100% in emergency situation. Endovascular treatment of the postaortic open surgery (PAOS) patient has fewer complications and a lower mortality rate in comparison with redo open surgical repair. Two cases of ruptured abdominal aortic aneurysm (AAA) were managed with the conventional open surgical repair. Subsequently, spiral contrast computer tomography scans showed reperfusion of the AAA sac remnant mimicking a type III endoleak. These graft-related complications presented as vascular emergencies, and in both cases endovascular aneurysm repair (EVAR) procedure was performed successfully by aortouniiliac (AUI) stent graft and femorofemoral crossover bypass. These 2 patients add further merit to the cases reported in the English literature. This highlights the crucial importance of endovascular grafts in the management of such complex vascular problems.