Evaluate the outcome and identify predictive failure of outpatient laparoscopic cholecystectomy

To evaluate the outcome of undertaking out-patient laparoscopic cholecystectomy (OLC) and identifying its predictive failures.

One hundred and forty-nine consecutive patients with symptomatic cholelithiasis scheduled for preplanned elective laparoscopic cholecystectomy (LC) from August 2004 to December 2006 were included in the study. Patients with associated severe diseases, ASA class III and IV who would have required post operative surgical care, residents of remote areas and other surgical reasoning were entered in Inpatient's Laparoscopic Cholecystectomy (ILC) group (n = 57) and others were enrolled in OLC group (n = 87). Five patients converted to open surgery and thus were excluded from the study. All patients were recruited during the initial outpatient visit and the full preoperative details were explained to them. All of the related factors of OLC were recorded in every visit. Significant differences were evaluated using Chi-square and fisher exact test.

Eighty seven patients (58.3%) were selected for outpatient group from which 69 patients (79.3%) successfully underwent outpatient LC. Eighteen (20.7%) patients (failure rate) were not discharged at all. Comparing successful and unsuccessful OLC, the mean age was 41.1 +/- 12.7 vs 51.3 +/- 16.1 years (P = 0.005), also the mean operation time was 33.7 +/- 13.3 vs 33.1 +/- 13.8 minutes and the ability for oral intake existed in 66 patients (95.7%) vs 15 patients (83.3%) (P = 0.1) respectively. Pain was the most common cause of failure of OLC.

OLC is safe and feasible with low readmission. It achieves high levels of patient satisfaction and acceptance, when patients are carefully selected. A prospective study with a larger sample size should be warranted to verify whether OLC can be useful for high age and high ASA class patients.