Cholesafe 1.0

Recommendations for Cholecystectomy

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• BBUGSS does not support individual isolated, low volume cholecystectomy practice (<10 procedures/year/surgeon). Surgeons delivering low volume, should work within the framework and collaboration of a collective unit of surgeons within a Hospital/Trust delivering a cholecystectomy service for the purpose of audit, governance and service development

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• Annual audit of outcomes

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• Surgeons performing laparoscopic cholecystectomy should be able to offer intra-operative imaging (OTC/Laparoscopic Ultrasound)

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• Sub-total cholecystectomy is less optimal treatment compared to total cholecystectomy due to potential problems with remnant gallbladder/gallstones. But both open and laparoscopic subtotal cholecystectomy are valid treatment options for safety where Calots dissection is deemed difficult/hazardous​

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• Day case (not overnight stay) rate for elective laparoscopic cholecystectomy: standard 50%, aim >75% (accepting geographical remoteness in some regions might limit this)

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• Proportion of index (within 7 days) laparoscopic cholecystectomy for acute cholecystitis: as minimum >35%

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• Proportion of index or within 2 weeks laparoscopic cholecystectomy for gallstone pancreatitis in surgically suitable patients standard should aim for >95%

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• Proportion of patients undergoing elective and emergency laparoscopic surgery: <5% conversion rate to open

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• Low rates of planned open cholecystectomy (exception complex cases)

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Key Performance Indicators 

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• Readmission rates after cholecystectomy within 30 days <10%

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• Unexpected Day Case LC re-admission <5%

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• Overall Morbidity < 10%

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• Bile Leak rate after elective surgery (Cystic duct/Small liver bed duct-Strasberg A) < 1.5%

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• Retained CBD stones (within 90 days of cholecystectomy) < 2.5%

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• Unit Bile Duct Injury rate (Non-Strasberg A) < 0.3%

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• Unit Mortality < 0.1%