TPW 7.02 A Pragmatic Approach to Symptomatic Gallstone Disease: Outcomes of Selective Wait and Watch
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ID: 323951
2026
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Abstract
Abstract Aims NICE and Tokyo guidelines recommend cholecystectomy for symptomatic gallstone disease, with early surgery following acute presentations of cholecystitis, cholangitis, or pancreatitis. Ongoing pressure on emergency theatre capacity and prolonged elective waiting lists have led to the adoption of a watchful waiting strategy locally. This study evaluated outcomes of this approach in patients with acute gallstone presentations. Methods A retrospective study included patients presenting with acute gallstone symptoms over an 18-month period. Demographics, management strategy, complications, length of stay, and re-presentation patterns were analysed. Results A total of 249 patients were included, median age 58 years (IQR 51–77). Index admission cholecystectomy was performed in 42 patients. Seventy patients underwent elective surgery, including 67 laparoscopic, 2 subtotal, and 1 open procedures. Postoperative morbidity was low, comprising 1 bile leak, 1 postoperative collection, 1 stump cholecystitis, and 2 cases of non-specific pain. Of 139 patients managed conservatively, 100 (72%) did not re-present with recurrent symptoms. Only Thirty-nine patients re-presented, predominantly with similar or less severe pathology and no progression to complicated disease. Median re-admission length of stay was 2 days (IQR 3–8). Most patients required no further inpatient intervention following index presentation. All patients presenting with gallstone ileus were aged over 85 years and recovered without major complications. Conclusions A selective wait-and-watch approach for patients with uncomplicated disease or low symptom burden is associated with acceptable outcomes and enables index admission laparoscopic cholecystectomy within emergency theatre capacity for patients with complicated disease, such as pancreatitis or higher symptom burden.
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openalex_W7172496644
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| Authors | Tanya Bhalla, James Flynn, David Kenneth Harries |
| Journal | the british journal of surgery |
| Year | 2026 |
| DOI |
10.1093/bjs/znag087.372
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| URL | |
| Keywords | Keywords not found |
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