72 A Decade of Hot Choles: Sharing the Experience of Emergency Laparoscopic Cholecystectomy in a Single NHS District Hospital

Abstract Background Emergency laparoscopic-cholecystectomy, or "hot chole," is increasingly adopted as the preferred approach for managing acute-gallbladder pathology during index-admission. While it offers benefits such as reduced hospital-stay and lower recurrence of biliary-events, it is technically more challenging than elective surgery. Among these, the bill-leak remains a serious concern. This study aimed to assess the postoperative outcomes of hot-chole and identify factors associated with bile leak, complications, and readmissions. Method A retrospective analysis was conducted on 785 emergency laparoscopic cholecystectomies performed between 2013-2024 at a single NHS-general-district-hospital. Elective procedures and incomplete cases were excluded. Logistic regression was used to identify predictors of bile leak, postoperative complications, and 30-day readmission. Results The overall bile-leak rate was 2.4% (19/785). Univariate-analysis showed a significant association between bile-leak and gangrenous-gallbladder (42.1% vs 6.6%, p = 0.02). Other factors such as acute cholecystitis (p = 0.74), CBD dilatation (p = 0.17), and IOC use (p = 0.96) were not significantly associated with bile leak. The 30-day readmission-rate was 8.2%, and the overall postoperative complication rate was 7.9%, including wound infection (3.6%), retained stones (2.0%), and postoperative bleeding (1.8%). Multivariable analysis identified male-sex (OR 4.4, p = 0.017) and ASA ≥3 (OR 3.3, p = 0.013) as independent predictors of postoperative-complications. Conclusions Bile-leak following emergency laparoscopic-cholecystectomy remains rare but is more frequent in patients with gangrenous-gallbladders and higher ASA-grades. IOC did not appear to reduce the risk of a bile-leak. Male sex and significant-comorbidities were independent predictors of postoperative-complications. These findings support selective IOC use and enhanced perioperative vigilance for high-risk patients.