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Jonas Leo, Goran Filipovic, Julia Krementsova, Rickard Norblad, Mattias Söderholm and Erik Nilsson*
Corresponding author: Erik Nilsson firstname.lastname@example.org
BMC Surgery 2006, 6:5 doi:10.1186/1471-2482-6-5
(2009-03-06 21:01) Instituion of surgery and perioperative sciences, Umeå university, Sweden
In our study, hospital stay for all patients (3.1 days) was compared with hospital
stay for all patients who had cholecystectomy in Sweden 2002 (4.4 days). However,
in a subsequent study we found that after exclusion of patients with malignant or
benign intra-abdominal or kidney tumor with a procedure code for tumor resection,
the mean in-hospital stay for patients who had cholecystectomy in Sweden 2002-03 was
4.1 days. After adjustment for 12% ambulatory cholecystectomies in Motala Hospital,
the best comparison would be 3.5 days for patients with in-hospital stay in Motala
versus 4.1 for Sweden. However, the main message of the report is that open cholecystectomy
and concomitant removal of bile duct stones, should be considered a cost-effective
alternative in a unit with emergency service and trainee surgeons, provided small-incision
surgery is aimed for. We agree totally with Dave Hopkins that the incision should be as wide as safety requires.
And furthermore, trainees should be assisted by senior colleagues during critical
moments in all gallbladder surgery. For the authors, Erik Nilsson, M.D., Ph.D. 1. Rosenmuller M, Haapamaki MM, Nordin P, Stenlund H, Nilsson E: Cholecystectomy in
Sweden 2000-2003: a nationwide study on procedures, patient characteristics, and mortality.
BMC Gastroenterol 2007, 7:35.
The authors declare that they have no competing interests.
(2006-04-25 11:29) other
The only possible contraindication to an open small incision cholecystectomy is that
an unexperienced surgeon may be impacted by the limited range of the field. However,
seeing as many of these cases were elective cases, unexperienced surgeons probably
did not perform them. Looking at this scenario from the perspective of a busy Emergency
Department, I would have to say that during a time of increased patient flow or heavy
trauma, a case like this would be deemed a non-life-threatening emergency and would
most likely be handed off to a less experienced surgeon. This could result in extreme
morbidity or mortality in a severe case. This is a very unusual situation and may
never occur. But, this is a subject and scenario that could possibly be postulated
before such a scenario became standard procedure.
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