DAY CARE LAPAROSCOPIC CHOLECYSTECTOMY
A FEASIBLE OPTION
MUHAMMAD ZUBAIR, M. JUNAID DINARWALA, ANIS HUSSAIN JAFFERY*
Department of Surgery, Hamdard College of Medicine & Dentistry, Karachi
Department of Surgery, Ziauddin Medical University, Karachi*
Objective: To evaluate the feasibility & outcome of Day care Laparoscopic Cholecystectomy in an independent
Design: Case series.
Setting & Duration: Advanced Surgical & Medical Clinic (a private day care unit) in Karachi from August 2001
to January 2005.
Methodology: Patients who presented with diagosis of cholelitiahisis and consented to day care laparoscopic
cholecystectomy were included. Selection criteria included age <60 years, ASA grade I & II, no signs & symptoms
of acute cholecystitis, normal liver function tests, weight <100 kg and adequate support. Duration of surgery,
complications, conversion, patients requiring overnight stay and factors responsible were analyzed.
Results: Day care Laparoscopic Cholecystectomy was attempted in 113 patients out of which 100(88.5%) were
female & 13(11.5%) male with mean age of 37.9 yrs. 99(87.61%)patients were discharged on the same day whereas
14(12.39%) stayed overnight, there were no readmissions. Causes of overnight stay included excessive post operative
nausea & vomiting in 5(4.43%), drain placement in 4(3.54%), conversion to open in 3(2.65%) & patient preference
in 2(1.77%). Complications included port site infection in 5(4.43%), port site hernia in 1(0.88%) & minor biliary
leakage in 1(0.88%).
Conclusion: Day care Laparoscopic Cholecystectomy is a feasible and safe option in selected group of patients in
an independent day care surgical unit
KEY WORDS: Day Care Surgery, Ambulatory Surgery, Laparoscopic Cholecystectomy, Outpatient Surgery
INTRODUCTION series supporting this as a safe and cost effective proce-
dure. Since then laparoscopic cholecystectomy in day
Laparoscopic cholecystectomy has become the gold care setting has been widely studied as supported by
standard for treatment of symptomatic gallstone disease studies by Mjaland5 and other authors as well.6,7
because of faster recovery, less postoperative pain,
earlier return to work and better cosmesis.1 Many studies have demonstrated the safety, feasibility
& cost effectiveness of Day care Laparoscopic Cholecys-
The potential of performing laparoscopic cholecystec- tectomy and in a meta analysis of five randomized con-
tomy as day care surgery was recognized early when trolled trials. Gurusamy concluded that Day care Lapa-
a trial published in New England Journal of Medicine roscopic cholecystectomy is a safe and effective treat-
in 1991 demonstrated length of stay as short as 6 hours.2 ment for symptomatic gallstones.8 It has become well
Fleming3 and Prasad4 presented their findings in their established in selected patients in many centres of the
developed world but information is limited from dev-
eloping nations,9-14 however Kaman15 and Chauhan16
from India have also reported it to be safe, feasible,
Correspondence: acceptable to patients and with social and economic
Dr. Muhammad Zubair benefits.
Assistant Professor of Surgery,
Hamdard College of Medicine & Dentistry, Karachi. METHODOLOGY
E-mail: firstname.lastname@example.org This study was conducted at Advanced Surgical &
182 Volume 24, Issue 3, 2008
Day Care Laparoscopic Cholecystectomy M. Zubair, M. J. Dinar
Medical Clinic (an independent day care unit with of epigastric and two of umbilical ports. One patient
facility of overnight stay if required) in Karachi over developed umbilical port site hernia seven months after
a three and a half year period from August 2001 to surgery.
January 2005. All patients who fulfilled the selection
criteria were counseled & booked for Day Care Laparos- DISCUSSION
copic Cholecystectomy. Selection criteria were age less
than sixty years, American Society of Anesthesiologists Our results demonstrate that day care laparoscopic
grade I & II, no signs & symptoms of acute cholecystitis, cholecystectomy is a safe and feasible option, as shown
normal liver function tests, weight less than hundred by Fleming3 in 2000, Siu10 from Hong Kong, Keule-
kilogram and adequate support which meant availability mans14 and Kaman.15 In day care surgery, patient selec-
of a responsible adult to care at home, access to telephone tion criteria have an impact on success rates, 87.61%
and ability to come to hospital if needed. discharge rate and no readmissions indicate that the
selection criteria were appropriate even though day care
The perioperative and anaesthetic regimens were laparoscopic cholecystectomy has been demonstrated
standardized. Patients were admitted at 7.30a.m. and to be safe in older and high risk (ASA grade III) pati-
operated at 8.00a.m., mobilized around 2.00p.m. and ents.17 Discharge rates in the published literature vary
discharged between 6.00 & 8.00p.m. after being greatly from 55 to 100%.18 It is felt that with increasing
reviewed by the surgeon. 1.5 gm Cefuroxime was used experience a wider range of patients can be submitted
for prophylaxis and Diclofenac 100mg suppository and to day care laparoscopic cholecystectomy.
pot site infiltration of Bupivacaine was used in all
patients. A single dose of Inj. Diclofenac Sodium was The mean age of 37.9 years in this study is less as com-
administered 6 hours after surgery. Telephone numbers pared to other local studies because of selecting patients
of the surgeon & manager were given to the patient for less than 60 yrs and only ASA grade I & II whereas the
contact if required. sex distribution matches well with Saeed19 and Khan.20
The mean operative time of 43 mins is also in accordance
RESULTS with that mentioned by Khan20 from Karachi in 2007,
Jain21 in 2005 and Lau.22 It has been reported that length
A total of 113 patients were booked for Day Care Lapa- of operation is an independent predictive factor for un-
roscopic Cholecystectomy (DCLC), out of which 100 anticipated admission and on operative time exceeding
(88.5%) were female & 13(11.5%) male with mean age 60 minutes incurred a 4-fold increased risk.23
of 37.9 years (range 16 to 59 yrs). The mean operative
time was 43 minutes ranging from 25 to 90 minutes. The reasons for overnight admission that have been
reported include nausea & vomiting, pain, conversion,
Out of these 113 patients ninety nine (87.61%) were patient preference, drain placement and retention.23
discharged on the same day whereas fourteen (12.39%) Complications and reason for conversion are same whe-
had to stay overnight, however during this study there ther Laparoscopic cholecystectomy is performed in
were no readmissions. Causes of overnight stay included daycare or admission setting but excluding obese patients
excessive post operative nausea & vomiting in five and those with acute cholecystitis reduces the incidence
(4.43%), drain placement in four (3.54%), conversion in day care surgery.
to open cholecystectomy in three (2.65%) & patient
preference in two (1.77%) Table I. Complications CONCLUSION
occurred in seven out of the 113 patients operated. One
patient had minor biliary leakage which settled in three Day care Laparoscopic Cholecystectomy is a feasible
days, five (4.43%) patients had port site infection, three and safe option in selected group of patients in an
independent day care surgical unit
Table I. Reasons for overnight stay
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This Article was submitted by corresponding author
after the demise of Dr. Junaid Dinarwala
184 Volume 24, Issue 3, 2008