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Day case laparoscopic cholecystectomy in children: A review of 11 cases
Prakash Agarwal1, Raj Kishore Bagdi1
1Department of Pediatric Surgery, Apollo Children's Hospital, Chennai, Tamil Nadu, India.
Insights
Day case laparoscopic cholecystectomy is a safe and feasible surgical option for children. This approach, focusing on pain management and preventing post-operative nausea and vomiting, leads to high success rates and patient satisfaction.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Cholelithiasis in children is increasingly common.
- Laparoscopic cholecystectomy is the standard surgical treatment.
- Day case surgery offers potential benefits in pediatric care.
Purpose of the Study:
- To evaluate the outcomes of day case laparoscopic cholecystectomy (DCLC) in pediatric patients.
- To assess the feasibility and safety of a DCLC pathway in children.
- To analyze patient satisfaction and recovery parameters following DCLC.
Main Methods:
- Prospective data collection from March 2013 to November 2013.
- Utilized a clinical pathway emphasizing analgesia, PONV management, feeding, and mobilization.
- Monitored hospital stay, complications, post-discharge needs, convalescence, and patient satisfaction.
Main Results:
- 11 children with symptomatic cholelithiasis underwent DCLC.
- No intra- or post-operative complications were reported.
- Zero incidence of post-operative nausea and vomiting (PONV) and no readmissions.
- 4/11 patients experienced transient shoulder tip pain; no overnight stays were required.
Conclusions:
- A DCLC pathway is a safe and feasible option for pediatric patients.
- Effective pain management and PONV avoidance are crucial for successful day case surgery.
- Achieved day case surgery rates comparable to adult practice.
Aim:
The aim of this paper is to study the outcome of day case laparoscopic cholecystectomy (DCLC) in children.
Materials And Methods:
A clinical pathway for day care laparoscopic cholecystectomy was followed with emphasis on the analgesia, post-operative nausea and vomiting (PONV), feeding, mobilization, pain scoring and patient satisfaction. Demographic and clinical data were recorded prospectively from March 2013 to November 2013. The setup allowed easy access to an overnight stay if needed. Hospital stay, complications, the need for medical advice after discharge, convalescence and patients satisfaction were analyzed.
Results:
We admitted 11 children with symptomatic cholelithiasis for day case laparoscopic surgery. There were no intra- or post-operative complications. The incidence of PONV was 0/11. There was no readmission. 4/11 patients complained of shoulder tip pain on follow-up next day. There was no overnight stay.
Conclusions:
Adoption of a DCLC pathway is feasible and safe for children. Emphasis on adequate pain management and avoidance of PONV results in a high rate of day case surgery equivalent to that achieved in adult practice.
