Randomised Controlled Trial of Day-Case Laparoscopic Cholecystectomy vs Routine Laparoscopic Cholecystectomy

Abstract

Many randomised controlled trials conducted worldwide favours for day-case laparoscopic cholecystectomy, but questions have been raised regarding its application in developing country like ours. Hence, considering it a high time to review current practices, we conducted this trial to report our experience with day-case laparoscopic cholecystectomy and to access its feasibility and safety in our set-up. Data from 65 patients with symptomatic gallstone were randomised to perform laparoscopic cholecystectomy either as day-case procedure or as routine (conventional) procedure. Complication, quality of life, satisfaction, post-operative nausea and vomiting and pain were assessed. Ninety-seven per cent (31/32) of day-case laparoscopic cholecystectomy patients were successfully discharged with mean duration of 8.9 ± 4.54 h, which was 3.33 ± 1.45 days (72.92 ± 34.8 h) in routine (conventional) laparoscopic cholecystectomy group. There was no significant difference in complication, quality of life, satisfaction, post-operative nausea and vomiting and pain between the two groups. Day-case laparoscopic cholecystectomy is a safe, feasible and beneficial procedure in our set-up. Patient acceptance in terms of quality of life and satisfaction was similar to that of routine laparoscopic cholecystectomy.

The Safety of Laparoscopic Cholecystectomy in the Day Surgery Unit Comparing with That in the Inpatient Unit: A Systematic Review and Meta-Analysis

“…Postoperative Complications. Postoperative complications were reported in seven trials [32,33,[35][36][37][38][39] with 287 patients in the day surgery group and 294 patients in the inpatient group. In total, 15 out of 287 (5.2%) participants had postoperative complications in the day surgery group compared with 21 out of 294 (7.1%) in the inpatient group.…”

“…There were 10 studies [32][33][34][35][36][37][38][39] that compared the LC in the day surgery unit versus inpatient unit, and 2 of them [18,26] were retrospective controlled studies which were excluded from quantitative synthesis. Of the remaining 8 RCTs, there were 301 patients that underwent LC in day surgery units and 308 patients underwent LC in the inpatient units.…”

“…Visual Analogue Score (VAS). There were three studies [37][38][39] that reported the PONV with 196 participants in total. One study reported a higher PONV rate in the inpatient group (18.2% vs. 12.5%) than that in the day surgery group.…”

“…Five trials [32,35,[37][38][39] assessed the VAS of patients after operation, including 175 patients in each group. The heterogeneity was significant (p < 0:001; I 2 = 95%), but the exclusion of any one of the five studies did not change the results.…”

Laparoscopic cholecystectomy as a day surgery operation: two centers experience.

“…Hence, the admission rate was slightly high (11.76%) however the readmission (0.36%) rate was low. [21] Some reports demonstrated the safety of DSLC in older and high-risk patients (ASA grade III) while, others have concluded that a previous diagnosis of acute cholecystitis, acute biliary pancreatitis, and ASA >II were highly predictive of a hospital admission. [22][23][24] In our study, no patients with ASA grade more than II were included.…”