Saudi Journal of Gastroenterology
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ORIGINAL ARTICLE  
Year : 2011  |  Volume : 17  |  Issue : 4  |  Page : 277-279
Laparoscopic cholecystectomy as a day surgery procedure: Is it safe?--An Egyptian experience


1 Department of Surgery, National Hepatology and Tropical Medicine Research Institute, Egypt
2 Zagazig Medical College, Egypt
3 Department of Anaesthesia, National Cancer Institute, Egypt

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Date of Submission04-Jul-2010
Date of Acceptance10-Jan-2011
Date of Web Publication30-Jul-2011
 

   Abstract 

Background/Aim: Major surgery performed as a day surgery procedure is not uncommon. The aim of this study is to evaluate the feasibility of day surgery procedures in laparoscopic cholecystectomy (LC). Patients and Methods: A total of 210 patients scheduled for elective LC between 2006 and 2008 were included in our study. The mean age was 40.63 years (range, 25 - 70 years). The indication for surgery was symptomatic cholelithiasis confirmed by ultrasonography without clinical or radiological evidence of acute cholecystitis. All patients were informed about the same-day discharge policy and received the postoperative instruction form on discharge. Preoperative work-up included history taking and physical examination in addition to standard laboratory and radiological tests. Patients above 35 years of age had an ECG done. All patients were examined in the outpatient clinic by a consultant anesthesiologist the night before surgery. Operative time, hospital stay, and complications were recorded. Telephonic feedback, on the morning after surgery was routinely done as an early follow-up. Results: Out of the total number of patients, 140 patients were ASA (I) and 70 were ASA (II) (40 patients were controlled hypertensives and 30 were controlled diabetics). Conversion rate was 1.4%. The mean hospital stay was 6.7 hours (range, 6 - 8 hours). The mean operative time was 31.2 minutes (range, 20 - 60 minutes). None of the patients required an abdominal drain. No morbidities or mortalities were reported in this series. Conclusion: LC may be done as a day surgery procedure with optimal patient satisfaction and without complications.

Keywords: Cholecystectomy, day surgery, laparoscopic

How to cite this article:
Seleem MI, Gerges SS, Shreif KS, Ahmed AE, Ragab A. Laparoscopic cholecystectomy as a day surgery procedure: Is it safe?--An Egyptian experience. Saudi J Gastroenterol 2011;17:277-9

How to cite this URL:
Seleem MI, Gerges SS, Shreif KS, Ahmed AE, Ragab A. Laparoscopic cholecystectomy as a day surgery procedure: Is it safe?--An Egyptian experience. Saudi J Gastroenterol [serial online] 2011 [cited 2019 Oct 20];17:277-9. Available from: http://www.saudijgastro.com/text.asp?2011/17/4/277/82584


Laparoscopic cholecystectomy (LC) was first reported by Mouret in France in 1987 and two years later by Reddick in the United States in 1989. [1],[2],[3] LC has proven to be a safe procedure with multiple benefits to the patients, including reduced postoperative pain, smaller scars, shorter hospital stay, shorter convalescence period, and decreased risk of selected complications compared with open cholecystectomy. [2],[3],[4] Currently, the majority of patients undergoing elective LC are observed in the surgical ward or in a short-stay unit overnight. [5] Although several authors have documented the feasibility of outpatient management of patients undergoing LC, [6],[7],[8] wide acceptance of an actual same-day outpatient management requires a proof that there is no added risk to the patient from early discharge. [4] The current study presents the Egyptian experience of doing LC as a day surgery procedure.


   Patients and Methods Top


A total of 210 patients underwent elective LC. The mean age of this group was 40.63 years (range, 25 - 70 years). The indication for surgery was symptomatic cholelithiasis confirmed by ultrasonography, without clinical or radiological evidence of acute cholecystitis.

The exclusion criteria were as follows:

  1. Acute cholecystitis.
  2. Patient's residence outside Cairo city (50 km from the surgical center).
  3. Lack of telephonic contact (personal or caregiver).
  4. American Society of Anesthesiologists (ASA) III and higher.
  5. Patients who were converted to open technique.


All patients were informed about same-day discharge. Preoperative work-up included history, physical examination, standard laboratory, and radiological tests. Patients above 35 years of age had an electrocardiogram (ECG) done.

All patients were examined by a consultant anesthesiologist in the outpatient clinic the night before surgery. All patients received intravenous prophylactic antibiotic on induction and intravenous ondansetron as an antiemetic. Standard four-port technique was used. Operative time, hospital stay, and any complications were immediately recorded in the postoperative notes after surgery. Patients were kept in the recovery room for four hours for postoperative routine monitoring before being transferred to the discharge unit. On discharge, they received the postoperative instructions form. Telephonic feedback was taken the next morning, as a routine early follow-up.


   Results Top


There were 140 patients with ASA (I) and 70 patients with ASA (II) (40 patients were controlled hypertensives and 30 patients were controlled diabetics). Three (1.4%) patients were converted to open cholecystectomy; one because of Mirizzi's syndrome with difficulty defining correct anatomy and the other two because of acute edematous anatomy associated with liver cirrhosis. The mean hospital stay was 6.7 hours (range, 6 - 8 hours). The mean operative time was 31.2 minutes (range, 20 - 60 minutes). No patient required an intraoperative drain. All patients were prescribed oral nonsteroidal anti-inflammatory drugs three times a day for postoperative analgesia. Thirty (14.2%) patients received one injection of methadone before they were discharged from the day surgery unit. Neither morbidity nor mortality occurred in this series. All telephone calls on the next postoperative day were answered and patients' satisfaction with their management was rated on a 4-point scale (1 = No satisfaction, 2 = Satisfied, 3 = Good satisfaction, and 4 = Excellent satisfaction) [Table 1]. On the one-week postoperative follow-up visit, three patients showed local bruising at the site of umbilical port which resolved spontaneously. None of the patients developed wound infection.
Table 1: Patient satisfaction scale


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   Discussion Top


Nicholls reported his first series of day case patients in 1909. [8] Guidelines for Day Case Surgery had been published in 1985 by The Royal College of Surgeon of England, followed by the British Association of Day Surgery in 1989. Royal College of Surgeons of England defined a surgical day case patient as one "who is admitted for investigation or operation on a planned non-resident basis and who nonetheless requires facilities for recovery." [9] It is estimated that 60 to 80% of surgeries will be performed as day surgery cases in the near future. [1],[10] The attraction of day surgery to hospitals and purchasers of healthcare is based on the expected financial benefits. It was concluded that selective performance of day surgery LC could result in an average baseline cost saving of more than $700 for each patient. [10] Day surgery is further encouraged by the federal government, businesses, private companies, and insurance providers, which now mandate outpatient management of certain procedures for appropriate patients. [7] Patients benefit from increased convenience, faster recovery, and early return to work. [7] Day surgery procedures are desired by patients who realize these benefits and want to assume more responsibility for their own health.

LC has largely replaced open cholecystectomy as a routine procedure for symptomatic cholelithiasis. Currently, the majority of patients undergoing elective LC are observed in the hospital or in a short-stay unit overnight. [4] As early as 1990, investigators began to evaluate the safety of same-day management of LC. Voitk [11] reported that 95% of LCs can be successfully managed in an outpatient setting. Moreover, he proposed that even high-risk patients (ASA III and higher) can usually be managed as day cases without undue complications or the need for admission. In this series, we selected our patients to be in ASA I and ASA II categories. ASA III patients were excluded from this study. Lillemoe et al.[4] noted that only 4.6% of 130 "true" outpatient LC patients required readmission, mostly for intractable nausea. In this study, the rate of readmission was zero. Curet et al.[12] concluded that patients who undergo elective LC should be offered early discharge from the hospital as long as they live relatively close to a medical center and have adequate assistance at home. Actually, major complications associated with LC, like bowel injury, are rare and occur in less than 1% of cases. [13] Also, when they occur, they tend to remain unrecognized during the primary operative admission. [14],[15],[16],[17] Fortunately, there was no bowel injury or other major complication in our series; only three patients reported bruising at the site of umbilical port which resolved spontaneously.


   Conclusion Top


We conclude that day surgery LC should continue to be applied selectively based on the experience of the responsible surgeons and the characteristics of the participating medical environment and patient population. LC can be safely done as a day surgery procedure with optimal patient satisfaction and without serious complications in Egypt.


   Acknowledgement Top


We thank Professor M.A. Wali (Consultant Vascular Surgeon), Saudi Arabia, for his invaluable help in reviewing the manuscript.

 
   References Top

1.Fiorillo MA, Davidson PG, Fiorillo M, D'Anna Jr JA, Sithian N, Silich RJ. 149 ambulatory laparoscopic cholecystomies. Surg Endosc 1996;10:52-6 .  Back to cited text no. 1
    
2.Narain PK, DeMaria EJ. Initial results of a prospective trial of outpatient laparoscopic cholecytectomy. Surg Endosc 1997;11:1091-4.  Back to cited text no. 2
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3.Zegarra RF, Saba AK, Peschiera JL. Oupatient laparoscopic cholecytectomy: Safe and cost effective? Surg Laparosc Endosc 1997;7:487-90.  Back to cited text no. 3
    
4.Lillemoe KD, Lin JW, Talamini MA, Yeo CJ, Snyder DS, Parker SD. Laparoscopic cholecystectomy as a "true" outpatient procedure: Initial experience in 130 consecutive patients. J Gastrointest Surg 1999;3:44-9.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Reddick EJ, Olson DO. Outpatient laparoscopic laser cholecytectomy. Am J Surg 1990:160;485-7.  Back to cited text no. 5
    
6.Arregui MD, Davis CJ, Arkush A, Nagan RF. In selected patients outpatient laparoscopic cholecystectomy is safe and significantly reduces hospitalization charges. Surg Laparosc Endosc 1991;1:240-5.  Back to cited text no. 6
    
7.Davis JE. The future of major ambulatory surgery. Surg Clin North Am 1987;67:893-901.  Back to cited text no. 7
[PUBMED]    
8.Nicholls J. The surgery of infancy. BMJ 1909;ii:753-4.  Back to cited text no. 8
    
9.The Royal College of Surgeons of England. Commission on the provision Surgical Services. Report of Working Party on Guidelines for Day Case Surgery. London: The Royal College of Surgeons of England; 1992.  Back to cited text no. 9
    
10.Fleisher LA, Yee K, Lillemoe KD, Talamini MA, Yeo CJ, Heath R, et al. Is outpatient laparoscopic cholecytectomy safe and cost-effective? Anesthesiology 1999; 90: 1746-55.  Back to cited text no. 10
[PUBMED]  [FULLTEXT]  
11.Voitk A. Establishing outpatient cholecytectomy as a hospital routine. Can J Surg 1997;40:282-8.  Back to cited text no. 11
    
12.Curet MJ, Contreras M, Weber DM, Albrecht R. Laparoscopic cholecystectomy: Surg Endosc 2002;16:453-7.  Back to cited text no. 12
    
13.Shea JA, Healey MJ, Berlin JA, Clarke JR, Malet PF, Staroscik RN, et al. Mortality and complications associated with laparoscopic cholecystectomy. Ann Surg 1996;224:609-20.  Back to cited text no. 13
[PUBMED]  [FULLTEXT]  
14.Soper NJ, Brunt LM, Kerbl K. Laparoscopic general surgery. N Engl J Med 1994;330:409-19.   Back to cited text no. 14
[PUBMED]  [FULLTEXT]  
15.Mirza DF, Neoptolemos JP. Modern management of gallstones. Postgraduate Surg 1996;6:14-8.  Back to cited text no. 15
    
16. Tait N, Little JM. The treatment of gall stones. BMJ 1995;311:99-105.  Back to cited text no. 16
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17.Lam D, Miranda R, Hom SJ. Laparoscopic cholecystectomy as an outpatient procedure. J Am Coll Surg 1997;185:152-5.  Back to cited text no. 17
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
Mohamed I Seleem
Consultant General and Laparoscopic Surgeon, 11, Mo-ezz El-Dawlah Street, Makram Obeid Street Nasr City-Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.82584

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