Day-case Laparoscopic Cholecystectomy Research Articles

Association of day-case rates with post COVID-19 recovery of elective laparoscopic cholecystectomy activity across England.

The aim of this study was to investigate the safety of day-case laparoscopic cholecystectomy, and the association between day-case rates and, post the COVID-19 pandemic, recovery of activity to prepandemic levels for integrated care boards (ICBs) in England. This was a retrospective observational study of the Hospital Episodes Statistics (HES) data set. Elective laparoscopic cholecystectomies for the period 1 January 2019 to 31 December 2022 were identified. Activity levels for 2022 were compared with those for the whole of 2019 (baseline). Day-case activity was identified where the length of stay recorded in the HES was zero days. Data were available for 184,252 patients across the 42 ICBs in England, of which 120,408 (65.3%) were day-case procedures. By December 2022, activity levels for the whole of England had returned to 88.2% of prepandemic levels. The South West region stood out as having recovered activity levels to the greatest extent, with activity at 97.3% of prepandemic levels during 2022. The South West also had the highest postpandemic day-case rate at 74.9% of all patients seen as a day-case during 2022; this compares with an England average of 65.3%. At an ICB level, there was a significant correlation between day-case rates and postpandemic activity levels (r = 0.362, p = 0.019). There was no strong or consistent evidence that day-case surgery had poorer patient outcomes than inpatient surgery. Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Increasing day-case rates may be important if ICBs in other regions are to increase activity levels up to and beyond prepandemic levels.

A O02 How effective is the right subcostal laparoscopically-guided transversus abdominis plane block on pain control after laparoscopic cholecystectomy? A randomised controlled trial

Abstract Background The transversus abdominis plane (TAP) block is effective on pain relief after laparoscopic cholecystectomy (LC). The procedure can be done under laparoscopic or ultrasound guidance and is often performed by injecting multiple abdominal areas. Data on the efficacy of the loco-regional block performed in the right subcostal region only are scanty. This study compared the effect of the right subcostal TAP block under laparoscopic guidance to the infiltration of local anesthetic to the port sites only (ILA) on pain relief, after elective LC. Methods A sample of 60 participants, 30 per arm, was estimated (two-sided a = 0.05%, power = 80%). Subjects having day-case (DC) LC were randomized into TAP block and ILA. Participants received Bupivacaine 0.5% 30 ml: TAP block – 20 ml in TAP block + 10 ml into the midline ports; ILA – 20 ml into the midline ports + 10 ml into the right-sided ones. Pain scores at rest at 1-hour post-surgery and at discharge, were evaluated with the Visual Analogue Scale score system. DC rate, Quality of Recovery-15 questionnaires, oral intake of opioids at day 3 and 7, were assessed too. Results Subjects in the ILA group were all women (p=0.0007) and younger (43.8 vs 37.7 years, p=0.023) than the TAP block. The median postoperative pain scores were 0 vs 1 at 1 hour (95% CI -1.99 to 1, p=0.60), 0 vs 1.5 at discharge (95% CI -2 to 0.99, p=0.55). The DC rate was 93.1% vs 93.5% (p=0.39). Six (10%) patients remained in hospital after surgery (postoperative pain [3], nausea [1], challenging surgical procedure [1], late theatre schedule [1]). Questionnaire scores and oral opioids intake did not differ between groups, on postoperative day 3 and 7. Conclusions The laparoscopically-guided right subcostal TAP block did not provide additional benefit to ILA on pain control, after LC.

1304 Feasibility of Day-Case Laparoscopic Cholecystectomy in Paediatric Patients

Abstract Aim Standard approach for treatment of cholecystolithiasis is laparoscopic cholecystectomy (LC), however day-case laparoscopic cholecystectomy (DCLC) has not been established as standard procedure in paediatric population. This is to assess the feasibility and safety of DCLC in paediatric population focusing on post-operative outcomes as a measure of success and using a protocolised post-operative pain management approach. Method Data, which include demographics, surgeon (trainee/consultant), admission mode, length of stay, complications, and post-operative pain management as per hospital protocol were collected from the hospital database from 2016 to 2022. Patients who underwent DCLS were discharged within 23 hours. Telephone survey was conducted to investigate type and length of analgesia administered at home. Results 31 patients underwent LC with a day-case rate of 77%. 63% were female. Mean age was 11 years (3 - 16). Obesity and haemolytic disorders were present in 29% and 8%, respectively. 96% were elective admissions. 20% had ASA I, 48% ASA II and 32% ASA III. Post-operatively, opioids with paracetamol/ibuprofen were administered in 96%, and in 80% as post-discharge analgesia. Post-discharge analgesia was administered 1 - 7 days, and 28% used oral opioid analgesia at home up to 3 days. Post-operative complications were present in 2 patients - 1 infected umbilical wound and 1 persistent dyspepsia. Six months readmission rate was 8% due to hypogastric pain treated conservatively. After a 3-month follow-up, all the patients were discharged. Conclusions LC can be performed safely as a day case procedure with excellent outcomes using a standardised post-operative and post-discharge pain management protocol.

Outcome of Laparoscopic Cholecystectomy as a Day Case Procedure

Introduction: Gallstone disease, a condition caused by the development of stones in gall bladder, usually presents with pain in upper abdomen, is one of the most common diseases of digestive system. It can be treated by the surgical removal of gall bladder, either through open cholecystectomy or by laparoscopic cholecystectomy (key hole surgery); the latter allows patients to be discharged from hospital on the day of their surgery, a concept known as day case surgery. Material and Methods: It was a descriptive case series in which 100 patients were selected through non probability, consecutive sampling. Inclusion and exclusion criteria were applied. Patients were assessed by anesthetist and consultant surgeon before undergoing laparoscopic cholecystectomy. After surgery, patients were encouraged intake of liquids and were discharged from the hospital as soon as they fulfilled the discharge criteria. Unplanned overnight admissions determined the outcome of this study. Results: 86% patients were discharged on the same day of surgery and 14% patients had an overnight stay after surgery. There were no readmissions but 3% of the patients presented for an unexpected consultation. Post stratification values of overnight admissions with age and BMI were found to be statistically significant while those for gender and duration of symptoms were found to be statistically insignificant. Conclusion: Patient selection is an important factor that affects the outcome of laparoscopic cholecystectomy, which is mostly an effective procedure. This study will help in the adoption of laparoscopic cholecystectomy as a day case procedure which is an effective way of reducing burden on health care resources. Keywords: Cholecystectomy, day case laparoscopic cholecystectomy (DCLC), laparoscopic surgery (LC).

Feasibility of Day-Case laparoscopic cholecystectomy: A narrative review

Gallstone disease was considered a rare disease in West African subregion, however with increasing urbanisation and lifestyle change, the incidence of the disease is rising. Laparoscopic cholecystectomy is the best treatment for gall stone disease. Initially, laparoscopic cholecystectomy required inpatient care after surgery, but for the past 30 years, there is a shift toward performing the procedure as a daycase. Day-case laparoscopic cholecystectomy was first reported in early 1990s, but in most countries of West Africa, cholecystectomy is still an inpatient procedure and this has been an additional strain to the health-care community as the number of personnel needed for postoperative care can be directed toward the care of other patients if the surgery is performed as a daycase. It has also been reported that increased use of day surgery would reduce waiting times and reduce last minute cancellations by the hospital. Although laparoscopic cholecystectomy was added to the basket of day-case procedures in the early 1990s, initial progress was slow because the procedure was not widely accepted as suitable for day case surgery. In sub-Saharan Africa, only Sudan, Nigeria, Tanzania, and South Africa have reported attempts at day-case laparoscopic cholecystectomy with good outcome.

Meta-analysis and trial sequential analysis of randomized evidence comparing general anesthesia vs regional anesthesia for laparoscopic cholecystectomy.

BACKGROUNDIn an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy, the outcomes of such procedure under regional anesthesia (RA) have been evaluated. In the context of cholecystectomy, combining a minimally invasive surgical procedure with a minimally invasive anesthetic technique can potentially be associated with less postoperative pain and earlier ambulation.AIMTo evaluate comparative outcomes of RA and general anesthesia (GA) in patients undergoing laparoscopic cholecystectomy.METHODSA comprehensive systematic review of randomized controlled trials with subsequent meta-analysis and trial sequential analysis of outcomes were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards.RESULTSThirteen randomized controlled trials enrolling 1111 patients were included. The study populations in the RA and GA groups were of comparable age (P = 0.41), gender (P = 0.98) and body mass index (P = 0.24). The conversion rate from RA to GA was 2.3%. RA was associated with significantly less postoperative pain at 4 h [mean difference (MD): - 2.22, P < 0.00001], 8 h (MD: -1.53, P = 0.0006), 12 h (MD: -2.08, P < 0.00001), and 24 h (MD: -0.90, P < 0.00001) compared to GA. Moreover, it was associated with significantly lower rate of nausea and vomiting [risk ratio (RR): 0.40, P < 0.0001]. However, RA significantly increased postoperative headaches (RR: 4.69, P = 0.03), and urinary retention (RR: 2.73, P = 0.03). The trial sequential analysis demonstrated that the meta-analysis was conclusive for most outcomes, with the exception of a risk of type 1 error for headache and urinary retention and a risk of type 2 error for total procedure time.CONCLUSIONOur findings indicate that RA may be an attractive anesthetic modality for day-case laparoscopic cholecystectomy considering its associated lower postoperative pain and nausea and vomiting compared to GA. However, its associated risk of urinary retention and headache and lack of knowledge on its impact on procedure-related outcomes do not justify using RA as the first line anesthetic choice for laparoscopic cholecystectomy.

811 Should We Be Performing Day Case Laparoscopic Cholecystectomy (DCLC) After 3pm? Correlation Between Time of Operation and Post-Operative Hospital Stay

Abstract Introduction Laparoscopic cholecystectomy (LC) is a common daycase procedure. The British Association of Day Surgery (BADS) Procedure Directory sets out national performance targets for the number of LC’s treated as day cases. This study aimed to assess if operation time predicted unplanned inpatient admission. Method An annonymised retrospective review of all patients undergoing LC. The data was undertaken over two cycles. The first cycle was a 6-month period followed by a second cycle that was undertaken over three months. Data was obtained from multiple sources: discharge letters and the theatre data manager. Results Total number of cases was 160. In the first cycle, the zero night stay for DCLC was 56%, which lies within the top 50% of current national performance but is below the BADS target of 75%. In the second cycle, the zero-night stay was 70%, which falls just below the BADS target. While unplanned admissions resembled 30%. We had 136 cases underwent LC before 3 pm. While 24 cases had their operation after 3 pm. 19 patients out of those 24 stayed at the hospital. Conclusions The timing of operation of DCLC predicts inpatient admission; our data suggests that DCLC should not take place after 3pm in the afternoon.

Day case laparoscopic cholecystectomy: Identifying patients for a 'COVID-Cold' isolated day-case unit during the pandemic.

The UK practice of laparoscopic cholecystectomy has reduced during the COVID-19 pandemic due to cancellation of non-urgent operations. Isolated day-case units have been recommended as 'COVID-cold' operating sites to resume surgical procedures. This study aims to identify patients suitable for day case laparoscopic cholecystectomy (DCLC) at isolated units by investigating patient factors and unexpected admission. Retrospective analysis of 327 patients undergoing DCLC between January and December 2018 at Ysbyty Gwynedd (District General Hospital; YG) and Llandudno General Hospital (isolated unit; LLGH), North Wales, UK. The results showed that 100% of DCLCs in LLGH were successful; 71.4% of elective DCLCs were successful at YG. Increasing age (p = 0.004), BMI (p = 0.01), ASA Score (p = 0.006), previous ERCP (p = 0.05), imaging suggesting cholecystitis (p = 0.003) and thick-walled gallbladder (p = 0.04) were significantly associated with failed DCLC on univariate analysis. Factors retaining significance (OR, 95% CI) after multiple regression include BMI (1.82, 1.05-3.16; p = 0.034), imaging suggesting cholecystitis (4.42, 1.72-11.38; p = 0.002) and previous ERCP (5.25, 1.53-18.00; p = 0.008). Postoperative complications are comparable in BMI <35kg/m2 and 35-39.9kg/m2. Current patient selection for isolated day unit is effective in ensuring safe discharge and could be further developed with greater consideration for patients with BMI 35-39.9kg/m2. As surgical services return, this helps identify patients suitable for laparoscopic cholecystectomy at isolated COVID-free day units.

Day case laparoscopic cholecystectomy at Kilimanjaro Christian Medical Centre, Tanzania

IntroductionThe Lancet Commission on Global Surgery has promoted the case for safe, affordable surgical care in low- and middle-income countries (LMICs). In 2017, Kilimanjaro Christian Medical Centre (KCMC) in Tanzania introduced a day case laparoscopic cholecystectomy (DCLC) service, the first of its kind in Sub-Saharan Africa (SSA). We aimed to evaluate this novel service in terms of safety, feasibility and acceptability by patients and staff.MethodsThis study used mixed methods and was split into two stages. In stage 1, we reviewed records of all laparoscopic cholecystectomies (LCs) comparing day cases and admissions. These patients were followed up with a telephone questionnaire to investigate complication rates and receive service feedback. Stage 2 consisted of semi-structured interviews with staff exploring the challenges KCMC faced in implementing DCLC.Results147 laparoscopic cholecystectomies were completed: 109 were planned for DCLC, 82 (75.2%) of which were successful, whilst 27 (24.8%) patients were admitted. No variables significantly predicted unplanned admission, the commonest causes for which were pain and nausea. In the DCLC group there was 1 readmission. 62 patients answered the follow up questionnaire, 60 (97%) of which were satisfied with the service. Stage 2 interviews suggested staff to be motivated for DCLC but revealed poor organisation of the day case pathway.ConclusionHigh rates of DCLC combined with low rates of complications and readmission suggests DCLC is feasible at KCMC. However, staff interviews alluded to administrative problems preventing KCMC from reaching its full DCLC potential. A dedicated day case surgery unit would address most of these problems.

Laparoscopic cholecystectomy by paediatric surgeons: can established standards of care be delivered?

Laparoscopic cholecystectomy (LC) case volume is low for paediatric surgeons relative to the adult sector; coupled with service differences, internationally accepted standards may be more challenging to meet. This study sought to determine (i) the outcomes of LC in children, and (ii) whether recognised care pathways (e.g. acute LC, access to cholangiogram/ERCP and day-case LC provision) can be delivered. Patients who underwent LC were identified retrospectively in a single institution between January 2009 and January 2019. Data are presented as median [IQR] and continuous variables compared using a t test. 101 cases were included (age 12.9 years [10.2–15]; female 65/101). Indications for LC were symptomatic gallstones (98/101) and polyps (2/101). ERCP and/or endoscopic ultrasound were performed in 23/101. For acute presentations, 7/24 (29%) had LC during the same admission. Trainees performed LC in 33/101. 4/101 required intra-operative cholangiogram. Operative time was 109.5 min [90.8–139.5]: consultant vs. trainee times were similar (114 [93.3–149.5] vs. 99.5 [81.5–125.3], p = 0.06). Length of stay was one day [1–1] with 10/101 being day-cases. There were no major complications or re-operations. We report good outcomes from LC. Furthermore, we have demonstrated the capacity to deliver recognised standards of care within a paediatric setting.

3D laparoscopy does not reduce operative duration or errors in day-case laparoscopic cholecystectomy: a randomised controlled trial

BackgroundContemporary 3D platforms have overcome past deficiencies. Available trainee and laboratorystudies suggest stereoscopic imaging improves performance but there is little clinical data or studies assessing specialists. We aimed to determine whether stereoscopic (3D) laparoscopic systems reduce operative time and number of intraoperative errors during specialist-performed laparoscopic cholecystectomy (LC).MethodsA parallel arm (1:1) randomised controlled trial comparing 2D and 3D passive-polarised laparoscopic systems in day-case LC using was performed. Eleven consultant surgeons that had each performed > 200 LC (including > 10 3D LC) participated. Cases were video recorded and a four-point difficulty grade applied. The primary outcome was overall operative time. Subtask time and the number of intraoperative consequential errors as identified by two blinded assessors using a hierarchical task analysis and the observational clinical human reliability analysis technique formed secondary endpoints.Results112 patients were randomised. There was no difference in operative time between 2D and 3D LC (23:14 min (± 10:52) vs. 20:17 (± 9:10), absolute difference − 14.6%, p = 0.148) although 3D surgery was significantly quicker in difficulty grade 3 and 4 cases (30:23 min (± 9:24), vs. 18:02 (± 7:56), p < 0.001). No differences in overall error count was seen (total 47, median 1, range 0–4 vs. 45, 1, 0–3, p = 0.62) although there were significantly fewer 3D gallbladder perforations (15 vs. 6, p = 0.034).Conclusion3D laparoscopy did not reduce overall operative time or error frequency in laparoscopic cholecystectomies performed by specialist surgeons. 3D reduced Calot’s dissection time and operative time in complex cases as well as the incidence of iatrogenic gallbladder perforation (NCT01930344).

Risk-based targeting of adjuvant pregabalin treatment in laparoscopic cholecystectomy: a randomized, controlled trial.

Background and aims Pain is the most common reason for delayed discharge after day-case laparoscopic cholecystectomy. This study investigates a simple five-item questionnaire in evaluating the risk of postoperative pain in day-case cholecystectomy and the efficacy and safety of single-dose preoperative pregabalin on patients with multiple risk factors for pain. There are no previous studies on targeting adjuvant pain treatment based on the individual risk factors like the preoperative state of anxiety, acute or chronic pain, and the expectation of pain in day-case surgery. Methods One hundred and thirty patients scheduled for day-case laparoscopic cholecystectomy were evaluated with a five-item questionnaire assessing the risk for postoperative pain. The patients with multiple risk factors (n=60) were randomized to receive either pregabalin 150 mg or placebo, 1 h before surgery. The primary outcome was abdominal pain intensity on numerical rating scale (NRS) 1 h after surgery. Pain, analgesic consumption and adverse effects during first three postoperative days, and the length of hospital stay were also recorded. Results Pregabalin 150 mg given as an adjuvant analgesic preoperatively did not decrease postoperative abdominal pain or opioid consumption in the first hour after surgery compared to placebo in a preselected group of patients with multiple risk factors for postoperative pain (p=0.31). Preoperative anxiety assessed with a scale of 0-10 had a positive association with postoperative pain (p=0.045). Conclusions and implications This was the first trial on systematically selecting patients with a high-risk factor profile for postoperative pain as a target for a preventive adjuvant analgesic intervention. Although numerous previous studies have identified various risk factors, including those used in the current trial, it seems to be challenging to use these risk factors as predictive tools for targeting adjuvant analgesics in day-case surgery. Preoperative anxiety has a positive association with postoperative pain in day-case laparoscopic cholecystectomy, and this should be taken into account when treating these patients.

Day-case laparoscopic cholecystectomy: analysis of the factors allowing early discharge.

Despite a number of studies have already demonstrated that majority of patients can be safely discharged early after laparoscopic cholecystectomy, this approach did not gain widespread diffusion yet. The present study was set up to assess safety and feasibility of 24 h or same-day discharge after laparoscopic cholecystectomy and to identify the prognostic factors. Perioperative variables of 229 patients undergoing cholecystectomy have been analyzed. Primary endpoints were: postoperative length of stay, rate of patients discharged within 24h, and rate of those discharged on the same day. Secondary endpoints were rate of 30-day readmission and rate of 30-day postoperative complications. Two-hundred twenty-three cases have been started by laparoscopy. Conversion rate was 3.1%. Overall mean postoperative stay was 1.8±3.5days (median 1day). Seventy-eight percent of patients have been discharged within 24h, and 22.3% have been discharged on the same day. Postoperative morbidity was 2.2%. Readmission rate was 3.9%. At univariate analysis, factors related to early discharge were age (more or less than 65), diagnosis (simple symptomatic gallstones vs complicated gallstones), ASA score, timing of operation (elective vs emergency), history of CBD stones, laparoscopic operation, and use of drain. No single factor was significantly related to readmission rate, but the use of drains in laparoscopic cases. At multivariate analysis, only elective operation, simple symptomatic gallstones, no history of CBD stones, laparoscopic approach, and no abdominal drain resulted independently associated with discharge within 24h from the operation. The predictive models are all fit and significant. Early postoperative discharge within 24h should be considered in all patients with simple symptomatic gallstones who had laparoscopic cholecystectomy. Same-day discharge should be considered if no drain was left at the end of the operation.

Single hospital visit elective day-case laparoscopic cholecystectomy without prior outpatient attendance.

Eighty percent of all UK elective laparoscopic cholecystectomies (LC) are performed as day-case procedures, but the pre-operative patient pathway has received little attention. In response to local patient feedback, we aimed to introduce a single hospital visit pathway for day-case LC. A single hospital visit pathway for elective LC was piloted alongside standard services. Following telephone consultation, a pack containing procedure information, knowledge questionnaire and consent form were sent. Patients were not excluded on age, BMI or co-morbidity criteria, but recent ultrasonography and liver function tests were required. Patients were operated without attending any clinic or pre-operative service. There was no restriction on surgical or anaesthetic technique. Early surgeon-led telephone follow-up was made post-operatively and patient satisfaction assessed at 3months. One hundred and sixty-six patients were referred with 92% transferred to day-case waiting lists following telephone consultation. One hundred and six patients underwent LC without previously visiting the hospital with 85% discharged the same day. Nine percent required post-operative primary care review primarily for wound reviews. Median patient-reported time to normal activities was 4weeks (range 1-12). Ninety-nine percent reported being satisfied with the single-stop pathway. Single hospital visit LC is feasible, safe and acceptable for primary care referral patients with symptomatic gallstone disease without evidence of common bile duct or LFT abnormalities.

Day-case laparoscopic cholecystectomy: analysis of 59 consecutive patients

Objective To evaluate the feasibility and outcome of laparoscopic cholecystectomy as a overnight procedure in China. Methods The data of 59 consecutive patients who had undergone outpatient laparoscopic cholecystectomy between January 2013 and January 2015. All the patients were operated in the morning hours and discharged during 24 hours after operation. They were contacted by telephone 3 days subsequent to surgery and were seen in the outpatient unit 7 days after. Results Fifty-nine laparoscopic cholecystectomies were performed. No Conversion to open surgery case. The average operation time was 25 minutes, and restore semi-liquid diet 6 hours after the operation All the 59 patients were discharged during 24 hours after operations. None of the patients had an emergency readmission. None of the patients had complications 7 days after discharged. The average payment was 8 240 yuan. Conclusion These results suggest that laparoscopic cholecystectomy can be routinely performed as a overnight procedure. Key words: Cholecystectomy, laparoscopic; Day-case laparoscopic cholecystectomy; Fast track surgery; Physician′s practice patterns

Factors predicting an increased length of stay after day-case laparoscopic cholecystectomy

Factors predicting an increased length of stay after day-case laparoscopic cholecystectomy

A study to determine risk factors for prolonged hospital stay after day-case laparoscopic cholecystectomy in comparison to risk factors for conversion to open

A study to determine risk factors for prolonged hospital stay after day-case laparoscopic cholecystectomy in comparison to risk factors for conversion to open

Day case Laparoscopic Cholecystectomy

Background: Day case laparoscopic cholecystectomy (DC-LC) is being practised in the USA and at sporadic centres in the UK including our department. The aim was to evaluate the initial experience of DC-LC at the unit. Patients &amp; methods: Prospectively collected data was analysed retrospectively. The case notes of all patients were retrieved from the medical records and reviewed individually. Standard laparoscopic cholecystectomy was performed. All patients had anti-DVT prophylaxis (pneumatic compression and enoxaparin), per-operative antibiotic, oro-gastric tube, paracetamol suppository and local anaesthetic to all wounds. They were discharged the same day. The end point was 6-week follow-up (86% overall). Results: Over a 32-month period, 164 consecutive patients with symptomatic cholelithiasis and ASA score of III or less were included. M:F was 1:5 and median age 43y. There were two conversions. The direct admission rate (DAR) was 26/164 (14%). The indication for direct admission included observation alone (7/26), wound pain (6/26), nausea (3/26), suction drain (2/26) and operation in the afternoon (2/26). Six (3.6%) required re-admission. One had a cystic artery pseudo-aneurysm presenting with colonic bleeding and anot her with an injury to CBD. One had post-op mild pancreatitis and three had wound pain and bruising. Conclusion DC-LC is safe and feasible in non-acute patients with symptomatic cholelithiasis

Day-case laparoscopic cholecystectomy.

Objectives:To assess the safety and feasibility of laparoscopic cholecystectomy as a day-case procedure.Methods:All consecutive patients who were admitted to the day-surgery unit for laparoscopic cholecystectomy at the Department of Surgery, King Saud Medical City, Riyadh, Saudi Arabia from July 2009 to June 2013 were considered for this retrospective study. The medical records were reviewed for age, gender, presenting symptoms, laboratory findings, imaging studies, American Society of Anesthesiology (ASA) grade, anesthesia, conversion to open cholecystectomy, complications, the operating surgeons, pain management, nausea, and vomiting, overnight stay, readmission, morbidity, mortality, and outpatient follow up were collected and analyzed.Results:A total of 487 patients underwent laparoscopic cholecystectomy as a day case (ASA I=316, ASA II=171). Surgery was performed by high surgical trainees (HSTs) (n=417) and consultants (n=70) with conversion to open cholecystectomy in 4 patients. Twenty-two (5%) patients were admitted for overnight stay for different reasons, while 465 (95%) patients were discharged before 8 pm. Two patients (0.4 %) were re-admitted to the hospital due to abdominal pain. Five patients developed umbilical port site infection (1%). A total of 443 patients were satisfied (97%), while 14 (3%) were unsatisfied. There was no mortality or intra-abdominal septic collection.Conclusion:Day-case laparoscopic cholecystectomy is safe and feasible with optimal patient selection, education, and planned postoperative antiemetic and analgesia management.

Feasible Factors to Reduce Hospital Days after Laparoscopic Cholecystectomy

Purpose: Under the proper program, day-case laparoscopic cholecystectomy is feasible in the aspect of postoperative recovery consisting of satisfaction and postoperative complication. In this study, we plan a new protocol for laparoscopic cholecystectomy by analyzing factors that can reduce hospital days. Methods: A total of 175 patients who underwent three-day laparoscopic cholecystectomy were initially selected. Out of 175 patients, secondary selection was executed using inclusion criteria. The selected patients were scheduled for new two-day laparoscopic cholecystectomy, and 89 patients were included in the data analysis. This study elucidated the comparative analysis between the discharged in the postoperative day 0 group and the postoperative day 1 group. Results: The clinical characteristics were not significantly different between discharged in the postoperative day 0 group and the postoperative day 1 group. The combined diseases were not significantly different between the two groups. Post-operative complications in both groups were analyzed on the seventh day after the operation. No significant difference was observed between the two groups. Members of the patient group who were discharged on postoperative day 0 were given a survey regarding post-operative pain, desirability of discharge, and the level of satisfaction with patient education. The average score was 8.3 out of 10 points. In comparison of the total hospital cost between the two groups, the group discharged on postoperative day 0 had lower cost in all factors. Conclusion: We conclude that day-case laparoscopic cholecystectomy is as safe and effective as routine clinical pathway applied laparoscopic cholecystectomy in stable cardiovascular disease, uncomplicated pulmonary disease, and controlled DM patients.