Day Care Laparoscopic Cholecystectomy Research Articles

Day Care Laparoscopic Cholecystectomy: A Review

Gallstones, small solid formations within the gallbladder (GB), often necessitate intervention when symptomatic. The conventional approach involves their removal through a minimally invasive laparoscopic cholecystectomy (LC). Traditionally, patients undergo overnight observation post-surgery to detect potential complications. However, this practice results in unnecessary extended hospital stays, leading to delays in resuming daily activities, heightened risks of nosocomial infections and morbidity, increased financial burden, and a strain on hospital resources. In contrast to this, many developed nations have embraced a more efficient model where carefully selected patients can be discharged on the same day as the operation, eliminating the need for overnight admission. Recognizing the advantages of a shorter duration of surgery, a brief postoperative period, and a reduced incidence of complications, the concept of Daycare Laparoscopic Cholecystectomy (DCLC) has gained prominence. Beyond the medical benefits, patients benefit from early discharge, recovery in a familiar home environment with personalized care, minimal disruption to personal life, and decreased overall costs. Despite over a decade of global research confirming the feasibility and safety of DCLC, this approach has not been widely adopted in India. This review emphasizes the necessity for its integration into routine practice in developing countries like India. Embracing DCLC can significantly alleviate the burden on healthcare resources, enhance patient experience, and contribute to more efficient healthcare delivery.

Preoperative admission is non-essential in most patients receiving elective laparoscopic cholecystectomy: A cohort study.

We evaluated conventional overnight-stay laparoscopic cholecystectomy, focusing on the preoperative admission day, to assess the feasibility of implementing daycare laparoscopic cholecystectomy, which is currently underutilized in developing and some Asian countries. We retrospectively reviewed elective laparoscopic cholecystectomy data from March 2020 to February 2022 at a 700-bed tertiary hospital in Thailand. Variables included age, sex, body mass index, comorbidities, American Society of Anesthesiologists status, presence of preoperative anesthesiology visit, laparoscopic cholecystectomy indications, additional intraoperative cholangiography, and surgery cancellations. The primary focus was on preoperative treatment and monitoring needs; secondary outcomes included morbidity, mortality within 30 days, and prolonged hospital stay (>48 hours). Statistical analysis was conducted using the Fisher exact test, t-test, and logistic regression. The study included 405 patients. Of these, 65 (16.1%) received preoperative treatment, with 21 unnecessary (over) treatments and six under-treatments. Based on the results, approximately 12.1% (n = 49) of patients may have theoretically required preoperative admission and treatment. Multivariable analysis showed that the increasing of comorbidities was significantly associated with preoperative management (odds ratio [95% Confidence interval]: 7.0 [2.1, 23.1], 23.9 [6.6, 86.6], 105.5 [17.5, 636.6]) for one, two, and three comorbidities, respectively), but factors such as age, obesity, and American Society of Anesthesiologists status were not. The cohort had 4.2% morbidity (2.2% medical complications), with no mortality. Surgery cancellations occurred in 0.5%. In conclusion, on the basis of our data, a small proportion (12.1%) of patients undergoing elective laparoscopic cholecystectomy may require preoperative admissions to receive the necessary treatment, and most (87.9%) preoperative admissions may not provide treatment benefit. The traditional admission approach was safe but required re-evaluation for optimal resource management.

Psychological and sociodemographic factors for delayed patient discharge after daycare laparoscopic cholecystectomy.

Objective: To estimate the psychological and sociodemographic correlates of delayed discharge of patients undergoing Elective Laparoscopic Cholecystectomy. Study Design: Retrospective Cross-sectional Descriptive study. Setting: Department of Surgery, Fauji Foundation Hospital. Period: July 2019 and June 2022. Material & Methods: The study comprised reviewing medical records of 160 patients who underwent daycare cholecystectomy. It was noticed from patients’ medical records that patients were carefully selected for daycare surgery. Patients with comorbidities, previous upper intra-abdominal surgery, ultrasound findings of thickened gallbladder wall > 5mm were not offered day care surgery. For data collection a Performa was designed based on literature review. To assess psychological state, we applied Hospital anxiety and depression scale in Urdu. Descriptive statistics were calculated for the sociodemographic variables, mean and standard deviation was found for continuous variables and frequency percentages for categorical variables. Results: One hundred and thirty-one 131 (81.8 percent) of the 160 cholecystectomies could be sent home within 24 hours, whereas 29 (18 percent) required a lengthier hospital stay. One hundred and thirty-one 131 (81.8 percent) of the 160 cholecystectomies could be sent home within 24 hours, whereas 29 (18 percent) required a lengthier hospital stay. In LS group, the postoperative stay range was 2 –19. Observation of postoperative fever (n = 3), surgery-related causes postoperative pain (n= 6), delayed oral diet = 1, retained abdominal drain = 4, and postoperative complications (n= 3). Bowel injury (n = 2) and septicemia (n = 1) were serious postoperative consequences resulting in more prolonged hospital stay. PONV (n = 2), medical causes (n = 3), and patient preference (n = 7) were among the reasons for the prolonged hospital stay. Conclusion: While our study has a few limitations; it is a retrospective review with nonrandomized patient selection and a smaller sample size, we have established safety of day case laparoscopic cholecystectomy in select group of patients. Patients’ personal satisfaction was the most common reason for their overnight admission after day case LC which was because of number of sociodemographic factors.

COMPARATIVE STUDY OF EFFICACY OF ONDANSETRON VERSUS ONDANSETRON AND DEXAMETHASONE COMBINATION IN PREVENTING POSTOPERATIVE NAUSEAAND VOMITING AFTER LAPAROSCOPIC CHOLECYSTECTOMY

This study aims to compare the efcacy of Ondansetron alone versus Combination of Ondansetron and Dexamethasone in terms of preventing Postoperative Nausea and Vomiting, Pain and duration of hospital stay. Material And Methods:Aprospective interventional randomized control study was conducted in the Department of General Surgery, SGT Medical College Hospital and Research Institute, Gurgaon, Haryana. The randomization was done according to the standard methods to allocate the patients to either Group A(total 30 patients) receiving Ondansetron 4mg + 2ml normal saline (total of 3ml) intravenous (IV), 1 minute before induction of anesthesia and Group B (total 30 patients) receiving Ondansetron 4mg and Dexamethasone 8mg (total of 3ml) IV, 1 minute before induction of anesthesia. Adequate sample size of 60 patient fullling inclusion and exclusion criteria mentioned are studied. The data was collected in a pre-designed study proforma and statistical analysis was performed. The treatment and drug efcacy were compared between two groups in terms of postoperative nausea and vomiting, pain and duration of hospital stay. RESULT: The total incidence of post-op nausea and vomiting following administration of Dexamethasone along with ondansetron was 1 patient (3.3 %) whereas 15 patients (50%) in group where dexamethasone was not administered which is signicant. The 1 patient of Group B was a case of abdominal tuberculosis with brosis of stomach serosa. Marked relief in post-op pain and shorter hospital stay was observed in group B which was administered steroid. Conclusion: From this study, we can conclude that administration of steroid like dexamethasone along with Ondansetron has signicant role in prevention of post-op nausea and vomiting, pain and gives shorter hospital stay, making it a necessary step to be followed when performing Day-care Laparoscopic Cholecystectomy.

Effect of intraperitoneal magnesium sulfate in the prevention of postoperative pain in daycare laparoscopic cholecystectomy - A prospective randomized controlled trial.

This study evaluated the efficacy of intraperitoneal magnesium sulfate (MgSO4) in preventing postoperative pain after elective laparoscopic cholecystectomy (LC). It is a prospective, double-blinded, placebo-controlled, randomized trial which included 64 patients who underwent LC. Patients were equally randomized into Groups A and B. MgSO4 and normal saline were instilled in subdiaphragmatic space in Groups A and B, respectively, after creating pneumoperitoneum and before starting dissection. The Visual analogue Scale (VAS) was used to determine postoperative pain. Patients who received intraperitoneal MgSO4 had lower average VAS scores for the first 6 h postoperatively, and also, the time for the requirement of first analgesic was longer (3.6 ± 0.4 vs. 2.3 ± 1.0 h). The incidence of vomiting and the requirement for rescue antiemetic was also lower in Group A. Intraperitoneal instillation of MgSO4 reduces postoperative pain and vomiting following elective LC without incurring additional side effects.

Timing of unplanned admission following daycare laparoscopic cholecystectomy

BackgroundOutpatient laparoscopic cholecystectomy is the treatment of choice for symptomatic biliary colic. There is controversy regarding the optimal candidate, and postoperative observation time for patients receiving daycare laparoscopic cholecystectomy. MethodsA retrospective, multi-centred, case-control chart review was performed from January 1, 2009 to December 31, 2011 on consecutive patients undergoing planned laparoscopic cholecystectomy. Patient demographics, surgical details, and postoperative details were analyzed. Results1256 daycare laparoscopic cholecystectomies were performed. One-hundred and twenty-one (9.6%) required unplanned admission the day of surgery. Forty (3.2%) were re-admitted within one month of surgery. The median time from surgical procedure to unplanned day of surgery admission was 218 min ± 143. The unplanned admission patients were older (54.6 vs 45.1, p < 0.005), and had ASA scores 3 or higher (24% vs 3%, p < 0.005). Comorbid conditions associated with unplanned admissions included hypertension, cardiac conditions, and chronic pain. ConclusionsThe majority of patients can be successfully managed with daycare laparoscopic cholecystectomy. A median time of 4 h is sufficient for postoperative observation. Risk factors for unplanned admission include age, ASA, hypertension, diabetes, and chronic pain.

Short-stay daycare laparoscopic cholecystectomy at a dedicated daycare centre: Feasible or futile.

BACKGROUND:In the last decade, laparoscopic cholecystectomy (LC) has become a regular daycare surgery at many centres across the world. However, only a few centres in India have a dedicated daycare surgery centre, and very few of them have reported their experience. Concerns remain regarding the feasibility, safety and acceptability of the introduction of daycare laparoscopic cholecystectomy (DCLC) in India. There is a need to assess the safety and acceptability of the implementation of short-stay DCLC service at a centre completely dedicated to daycare surgery.PATIENTS AND METHODS:Comprehensive care and operative data were retrospectively collected from a daycare centre of our hospital. Postoperative recovery was monitored by telephone questionnaire on days 0, 1 and 5 postoperatively, including adverse outcomes.RESULTS:A total of 211 patients were admitted for DCLC during the period from November 2011 till November 2014, of whom 211 were discharged on the day of surgery. Two hundred and two patients could be discharged within 6 h of surgery. Mean operation time was 72 min. No patient required admission. No patient needed conversion to open surgery. Only 1 patient was re-admitted due to bilioma formation and was managed with minimal intervention.CONCLUSION:The introduction of short-stay DCLC in India is feasible and acceptable to patients. High body mass index (BMI) in otherwise healthy patients and selective additional procedures are not contraindications for DCLC.

Day-care laparoscopic cholecystectomy with diathermy hook versus fundus-first ultrasonic dissection: a randomized study.

To examine the impact of day-care laparoscopic cholecystectomy (LC) with ultrasonic scissors dissection versus diathermy hook dissection method in a randomized setting. From April 2012 to September 2014, a total of 169 elective day-care patients were randomized to undergo either laparoscopic cholecystectomy with ultrasonic scissors using fundus-first approach (n=88) or diathermy hook dissection starting from the triangle of Calot (n=79). Main measures of outcome were operative time, same-day discharge and intraoperative complications. Secondary outcome measures were postoperative pain (numeric rating scale), postoperative nausea and vomiting (PONV), readmissions and 30-day morbidity. Median operative time was similar in the ultrasonic dissection and diathermy hook dissection groups (45 vs 45min, p=0.95). Same-day discharge was possible in 77 patients (87%) in the ultrasonic dissection group and in 69 patients (87%) in the diathermy group, p=0.98. Intraoperative gallbladder perforations, mean intraoperative bleeding, postoperative pain and PONV at 1, 2 and 4h (p=0.78) did not differ significantly between the study groups. Day-care LC using either diathermy hook or ultrasonic dissection resulted in excellent same-day discharge in both groups (87%). LC with ultrasonic dissection does not offer any clinical advantages compared to diathermy dissection.

Randomized Controlled Trial Comparing Daycare and Overnight Stay Laparoscopic Cholecystectomy.

This present study sought to review the feasibility and patients' satisfaction of laparoscopic cholecystectomy to be perform as daycare procedure. Sixty-two patients with symptomatic gallstones were recruited within a year. They were randomized into overnight stay and daycare groups. The outcomes and post-operative complications were analyzed. Fifty-eight patients were eligible for analysis and four patients were excluded because of conversion to open cholecystectomy. All patients in daycare group reported no fever but two patients in the overnight stay group complaint of post-operative fever (p=0.150). The mean pain score using Visual Analogue Score (VAS) in daycare group was 2.93 but in the overnight stay was recorded as 3.59 (p=0.98). Five patients had post-operative nausea and vomiting (PONV) in daycare group compared to 2 patients in the overnight stay group (p=0.227). Patient's satisfaction were higher in the daycare group (p=0.160). All patients in daycare group were back at work within a week but in overnight stay, 11 patients had to stay off work for more than one week (p=0.01). Daycare laparoscopic cholecystectomy is safe and feasible. The satisfaction of daycare surgery is higher than overnight stay group. Patients' selection is an important aspect of its success.

Early Experience of Day Care Surgery in Nepal

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.

Day Care Laparoscopic Cholecystectomy: A Study of Feasibility and Safety in Qatar

Laparoscopic cholecystectomy (LC) is the treatment of choice for symptomatic gall bladder disease and is one of the most frequently performed operations in Qatar. Daycare laparoscopic cholecystectomy (DCLC) was started in 2003 offering many advantages over conventional laparoscopy including reduced demand for hospital beds. DCLC has been shown to be safe in many centers worldwide but in Qatar its feasibility and safety had not been studied. During the 24 months July 2003-July 2005 fifty-six cases of DCLC were studied. Inclusion criteria were aged less than 60years, Grade 1 and 2 anesthesia risk according to American Society of Anesthesiology (ASA), living within an hour's drive of the hospital, had telephone access, living with a responsible adult, capable of reaching the hospital with or without depending on emergency medical services (EMS), able to understand discharge instructions, agreeing to participate by informed consent and the presence of symptomatic gall bladder disease. Complicated cases were excluded. The success rate of DCLC (same day discharge) was 48/56 (86%), most patients being observed in the Daycare Unit (DCU)for 6-8 hours. Pain,post-operative nausea and vomiting (PONV) were the most common causes of failure. There were no re-admissions within 30 days of surgery. Complications were minor and most patients were highly satisfied with same day discharge from the hospital. We conclude that DCLC is safe, feasible and has potential benefits for the health care system in Qatar.Surgeons performing laparoscopic cholecystectomy should recognize the advantages of DCLC and offer this approach to their patients in uncomplicated cases

Day Care Laparoscopic Cholecystectomy: A Feasibility Study in a Public Health Service Hospital in a Developing Country

Day care laparoscopic cholecystectomy (DCLC) has been shown to be safe in centers with adequate infrastructure for day care surgery in economically advanced countries. However, the feasibility of applying this concept in public health service hospitals in less developed and developing nation needs to studied. Unique protocols need to be developed and tested, taking into account local conditions and infrastructural constraints. Patients less than 60 years old, graded I and II on the American Society of Anesthesiologists (ASA) physical status score, living within one hour traveling time and willing to make their own arrangements for a return to hospital in case of problems, were selected for DCLC. 291 cases (78%) out of 373 laparoscopic cholecystectomies done in one calendar year were found suitable for DCLC. The most common cause for omitting from DCLC was that the patient lived out of the defined area (57%). Four of 291 (1.3%) cases were cancelled due to medical condition; 270/287 (96.1%) were discharged the same evening as surgery; 6 patients were converted to open surgery; and 11 did not meet the necessary discharge criteria. Eight of 270 (2.9%) required readmission out of which 3 (1.1%) required intervention. Overall, incidence of complication rate was 3.4%. Analysis of data showed that results were comparable to previously published studies, hence extrapolating that inclusion and discharge criteria used in the study are valid. However, there are certain social constraints which hinder truly universal application of DCLC. DCLC is a safe and technically feasible concept, even in public health service centers without dedicated ambulatory surgery units. It has potential for much economical and social benefit in these countries.

Feasibility and safety of day care laparoscopic cholecystectomy in a developing country

Background: Although day care laparoscopic cholecystectomy (DCLC) has been shown to be safe in centres with adequate infrastructure for day care surgery, its feasibility and safety in developing countries has...

Intraperitoneal local anaesthetics via subphrenic catheter following laparoscopic cholecystectomy: Pain relief and pulmonary function

SummaryPain and pulmonary impairment continue to be major issues in the postoperative management of daycare laparoscopic cholecystectomy. 33 patients undergoing laparoscopic cholecystectomy were randomly assigned to one of two groups of postoperative pain management. The first group received prilocaine and bupivacaine via a subphrenic catheter inserted through a trocar incision at the end of laparoscopy. The second group received i. v. piritramid on request. Pain and alertness1 were assessed by visual analogue scales, pulmonary function by bedside spirometry and arterial blood gas analysis. There was no difference in pain scoring between groups, but pain relief was significantly faster in Group 1. No differences were found between groups in impaired postoperative forced vital capacity and peak expiratory flow, but only Group 2 patients developed hypercarbia. It is concluded that postoperative pain relief via a subphrenic catheter is faster, equally effective and associated with greater alertness and no hypercarbia. Impaired pulmonary function cannot be improved when applying prilocaine and bupivacaine via the subphrenic catheter, instead of giving i. v. piritramid.