Early Experience of Day Care Surgery in Nepal

B Gautam,Br Shrestha,Dr Singh,M R Joshi,S Shrestha,U Koirala

doi:10.31729/jnma.86

Abstract

The day care laparoscopic cholecystectomy (DCLC) is found to be safe and effective in developed countries. However, it has not been well accepted in our part of the world probably because of lack of infrastructures,established norms and published reports. We have analyzed the safety and feasibility of the procedure in the recently established first dedicated day care surgery centre of the country. All the patients with American society of anaesthesiologist (ASA) score I and II admitted for laparoscopic cholecystectomy are included. Operation are performed in the morning and closely observed till evening. Patients found to be medically fit to discharge; having a responsible person at home and who can make their own arrangements in case of problems were advised for discharge. Follow up was done by telephone call from next morning. Total 35 patients underwent laparoscopic cholecystectomy. Age range was between 16-65 years and most of them were females (88%). Only 30 patients were operated in early morning and were eligible for day care surgery. 25 (83%) Patients were advised for discharge but only 10 (33%) could make arrangement. Other 15 patients could not go home mainly due to different psychosocial reasons. Only one patient needed readmission and Complications observed were minor and relatively few. Day care laparoscopic cholecystectomy is safe and feasible in our set up. Acceptance of the procedure is expected to increase once it is regularly practiced and awareness in improved.

Highlights

The day care laparoscopic cholecystectomy (DCLC) is found to be safe and effective in developed countries
Main reason for refusing discharge in the remaining was social (Fear of pain, lack of responsible person at home, not having good transport access, residence at top floor of the house and not having lift, self-satisfaction to remain in hospital (Table 1), five patients were not discharged as none of them had their own resident in the city and they were staying at hotel
List of complications generally encountered in laparoscopic cholecystectomy with incidences (Table 2)

Summary

Introduction

The day care laparoscopic cholecystectomy (DCLC) is found to be safe and effective in developed countries It has not been well accepted in our part of the world probably because of lack of infrastructures,established norms and published reports. We have analyzed the safety and feasibility of the procedure in the recently established first dedicated day care surgery centre of the country. We have analyze the safety, feasibility, potential benefits and acceptance of the day care laparoscopic cholecystectomy in a fully dedicated first day care surgery centre of the country Joshi et al Early Experience of Day Care Surgery in Nepal system in comparison to the developed countries where there are established norms for day care surgery with rigorously monitored outcomes.[12]

Methods

Results

Discussion

Conclusion