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

Abstract

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 never been studied. Because of differences in the quality of health care delivery, western guidelines for day care surgery cannot be universally applied to developing countries. Patients and methods: Patients less than 65 years who were graded I and II on the American Society of Anesthesiologists physical status score, irrespective of their educational status, living within 20 km, and willing to make their own arrangements for a return to hospital in case of problems were selected for DCLC. Follow up was done by patients calling the hospital the morning after surgery. Results: 50% of the eligibility criteria were new; 313/383 patients were suitable for DCLC. The commonest cause for rejection was that the patient lived out of the defined area (50%). Altogether 92% were discharged within eight hours of surgery. The reasons for failure to discharge were the presence of abdominal drains in four (2%), nausea and vomiting in nine (3%), and conversion to open surgery in five (2%). Ten patients (3%) were readmitted; of these only two (<1%) had complications needing re-exploration. Analysis of results showed that the inclusion and discharge criteria were valid and that the readmission and complication rates as well as the ease and accuracy of follow up were comparable to published data. DCLC reduced waiting times and increased patient turnover and may have a positive impact on resident training. Conclusions: DCLC is safe, feasible, and has potential benefits for health care delivery in developing countries. Each surgical service needs to develop their own guidelines based on local patient demography.

Laparoscopic cholecystectomy and outpatient surgery

“…Similarly, a small number of failures from intra-or postoperative complications exist, which will diminish as experience is gained in both patient selection and surgical, anesthetic and nursing management scheduling. Its feasibility has been demonstrated in all settings and differing countries with rather similar results (10)(11)(12)(13)(14).…”

“…Asimismo hay que contar con un pequeño porcentaje de fracasos por complicación intra o postoperatoria que se irá reduciendo conforme se adquiera experiencia tanto en la selección de los pacientes como en la planificación del tratamiento quirúrgico, anestésico y de enfermería. Se ha demostrado su factibilidad en todos los ámbitos y distintos países con resultados bastante parejos (10)(11)(12)(13)(14).…”

A Successful Model for Laparoscopic Training in Mongolia

“…[9][10][11] With careful patient selection, the safety of sameday laparoscopic cholecystectomy has also been established. 1,12,13 The majority of this experience has been carried out in tertiary care centers and has not been well studied in rural centers. As with the experience in developed countries, there is a learning curve for the mastery of laparoscopic skills.…”

Factores asociados a ingreso no previsto tras colecistectomía laparoscópica en régimen de cirugía mayor ambulatoria

“…La tasa de reingresos es un indicador clave ya que nos muestra aquellos casos que en el momento del alta se encontraban bien y no se sospechaba que el pró ximo desarrollo de una complicació n obligaría a ingresar al paciente de nuevo. En nuestra serie hubo 10 reingresos (2,8%) (tabla 1), tasa similar a la publicaba por otros autores [13][14][15][16][17][18][19][20][21][22][23][24][25][26] (tabla 4). La tasa de reintervenciones es otro dato muy importante.…”