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Feasibility and safety of day care laparoscopic cholecystectomy in a developing country
S Bal1, L G S Reddy, R Parshad
1All India Institute of Medical Sciences, New Delhi, India. drsbal@yahoo.com
Insights
Day care laparoscopic cholecystectomy (DCLC) is safe and feasible in developing countries. This approach offers potential benefits for healthcare delivery, reducing wait times and increasing patient throughput.
Area of Science:
- Surgical Innovation
- Global Health
- Minimally Invasive Surgery
Background:
- Day care laparoscopic cholecystectomy (DCLC) is established as safe in developed healthcare systems.
- Its feasibility and safety in developing countries remain unstudied.
- Healthcare variations necessitate localized guidelines for day care surgery.
Purpose of the Study:
- To evaluate the safety and feasibility of DCLC in a developing country context.
- To assess the applicability of DCLC in resource-limited settings.
- To determine the potential benefits of DCLC for surgical services in developing nations.
Main Methods:
- Patients under 65, American Society of Anesthesiologists physical status I-II, living within 20 km, and with self-arranged transport were selected.
- Eligibility criteria included willingness to return if complications arose.
- Post-operative follow-up was conducted via patient phone calls the morning after surgery.
Main Results:
- 313 out of 383 patients (81.7%) were suitable for DCLC.
- 92% of patients were discharged within eight hours.
- Readmission and complication rates were comparable to published data, with only <1% requiring re-exploration.
Conclusions:
- DCLC is a safe and feasible surgical option for developing countries.
- The procedure demonstrates potential benefits for healthcare delivery, including reduced waiting times.
- Development of localized guidelines based on patient demographics is recommended for successful implementation.
Background:
Although day care laparoscopic cholecystectomy (DCLC) has been shown to be safe in centres with adequate infrastructure for day care surgery, its feasibility and safety in developing countries has never been studied. Because of differences in the quality of health care delivery, western guidelines for day care surgery cannot be universally applied to developing countries.
Patients And Methods:
Patients less than 65 years who were graded I and II on the American Society of Anesthesiologists physical status score, irrespective of their educational status, living within 20 km, and willing to make their own arrangements for a return to hospital in case of problems were selected for DCLC. Follow up was done by patients calling the hospital the morning after surgery.
Results:
50% of the eligibility criteria were new; 313/383 patients were suitable for DCLC. The commonest cause for rejection was that the patient lived out of the defined area (50%). Altogether 92% were discharged within eight hours of surgery. The reasons for failure to discharge were the presence of abdominal drains in four (2%), nausea and vomiting in nine (3%), and conversion to open surgery in five (2%). Ten patients (3%) were readmitted; of these only two (<1%) had complications needing re-exploration. Analysis of results showed that the inclusion and discharge criteria were valid and that the readmission and complication rates as well as the ease and accuracy of follow up were comparable to published data. DCLC reduced waiting times and increased patient turnover and may have a positive impact on resident training.
Conclusions:
DCLC is safe, feasible, and has potential benefits for health care delivery in developing countries. Each surgical service needs to develop their own guidelines based on local patient demography.
