Day-case laparoscopy revisited: have post-operative morbidity and patient acceptance improved?

Previous studies of day-case laparoscopy have indicated considerable post-operative morbidity, with high incidences of nausea, vomiting and pain, often resulting in overnight admission. These studies also indicate that 30% of patients would have preferred an overnight stay. Changes in day surgery anaesthetic practice since then have included the wider use of non-steroidal analgesics and the specific use of propofol, a new short acting anaesthetic drug, with improved recovery and anti-emetic properties. We audited 74 patients who had day-case laparoscopy for diagnosis or sterilisation, and found that the incidence of nausea and vomiting was lower than any previously recorded, and mean pain scores were minimal. No patient was admitted for recovery problems, despite the inclusion of afternoon procedures; two patients only were admitted for surgical complications. Despite considerable morbidity after their return home, only 8% of patients said they would have preferred an overnight stay. Changes in anaesthetic practice would seem to make day-case laparoscopy a more acceptable procedure than previously reported.