The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.
Letter 1: Prospective randomized trial using cost-utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease (Br J Surg 2009; 96: 1031-1040)
Sir Macafee and colleagues have identified an important issue with regard to the acute management of gallstone disease. Previous papers have focused on the feasibility and potential advantages offered by this approach, specifically a reduction in the duration of hospital stay, without any change in complications associated with the procedure 1 . However, a perception remains that this procedure is unnecessary as patients can be managed conservatively without detriment and brought back on an elective basis. This may be compounded by the fact that many centres do not have access to a CEPOD theatre to facilitate surgical intervention.
Although the evidence supports acute cholecystectomy from a clinical perspective, if we are to see the completion of a paradigm shift in the management of acute gallstone disease, robust data supporting the potential economic 2 and social benefits will be required to ensure that the appropriate infrastructure 3,4 is in place to support this practice.
As such, it was disappointing that the group terminated their study after an interim analysis and before recruitment of a full cohort of patients as this prevented any significant conclusions being drawn. The authors concluded that the evidence presented supported delayed cholecystectomy but, in our opinion, it supports the current practice of acute cholecystectomy for gallstone disease as a financially feasible option. Unfortunately, we have not yet provided robust financial evidence that will help drive the changes required in service provision to offer this procedure to all patients presenting with acute gallstone disease.