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Day Care Laparoscopic Cholecystectomy: Next Standard of Care for Gall Stone Disease
Lileswar Kaman1, Javid Iqbal1, Ishwar Bukhal2
1General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Day care laparoscopic cholecystectomy is a safe and effective outpatient procedure for selected patients in India. This study found it feasible with a low unplanned admission rate, demonstrating its success in a tertiary care setting.
Area of Science:
- Surgical innovation and patient management in gastroenterology.
- Outpatient surgical procedures and healthcare economics.
- Minimally invasive surgery outcomes.
Background:
- Assessing the viability, safety, and efficacy of same-day discharge laparoscopic cholecystectomy.
- Focus on a tertiary care center in India.
- Evaluating patient selection criteria for ambulatory surgery.
Purpose of the Study:
- To determine the feasibility, safety, and success of day care laparoscopic cholecystectomy.
- To evaluate outcomes in a tertiary care setting in India.
- To identify suitable patient candidates for outpatient gallbladder surgery.
Main Methods:
- Retrospective analysis of prospectively collected data (2004-2009).
- Inclusion criteria: symptomatic gallstones, <70 years, ASA I/II, local residents, home support, and communication access.
- Laparoscopic cholecystectomy performed, with patients discharged 6-8 hours post-op.
Main Results:
- 309 out of 602 (51.32%) laparoscopic cholecystectomies were performed on a day care basis.
- 13 patients (4.20%) required unplanned admission (conversions, MI, persistent nausea/vomiting).
- 296 patients (95.79%) were discharged on the same day.
Conclusions:
- Day care laparoscopic cholecystectomy is feasible and safe for selected patients in India.
- The procedure demonstrates equal effectiveness compared to traditional inpatient care.
- Supports the expansion of outpatient surgical services for cholecystectomy.
Background:
To access the feasibility, safety and success of day care laparoscopic cholecystectomy in a tertiary center in India.
Methods:
This is a retrospective analysis of prospectively collected data between 2004 and 2009 from a tertiary center in north India. All patients of symptomatic gallstone diseases having age less than 70 years, American Society of Anesthesiologists (ASA) grade I and grade II, living within 20 Kilometers of the hospital, availability of a responsible adult care taker at home, access to a telephone and a means of transportation to hospital if needed, underwent laparoscopic cholecystectomy under the care of the two participating surgeons, were considered for day care laparoscopic cholecystectomy. Clinical and operative data were recorded prospectively. All patients were discharged 6 to 8 hours after surgery with the advice to contact the surgical team over phone whenever necessary or on the day after discharge.
Results:
A total of 602 laparoscopic cholecystectomies were performed over a period of 6years, among them 309 (51.32%) were operated on day care basis. Nine patients in day care procedure group had conversion to open procedure (5 due to distorted anatomy of calot's triangle, 2 due to common bile duct stones, 1 due to bile duct injury and 1 due to bleeding from cystic artery stump). One patient had myocardial infarction and 3 had nausea and vomiting which failed to resolve by intravenous ondensteron and all these (13) patients (4.20%) needed unplanned admission to the hospital. Two hundred and ninety-six patients (95.79%) were discharged on same day.
Conclusions:
In conclusion day care laparoscopic cholecystectomy is feasible, safe and equally effective in selected patients in Indian setup.
