Limiting Factors for Day Care Laparoscopic Cholecystectomy in a Rural Setup

• Published in: Indian journal of surgery Vol. 86; no. 2; pp. 380 - 384
• Main Authors: Gupta, Amit Kumar, Srivastava, Niraj, Saurabh, Amritanshu, Srivastava, Yogesh
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.04.2024; Springer; Springer Nature B.V
• Subjects: Cardiac Surgery; Cholecystectomy; Developing countries; Gallbladder diseases; Laparoscopic surgery; Laparoscopy; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Neurosurgery; Original Article; Pediatric Surgery; Plastic Surgery; Surgery; Surgical clinics; Thoracic Surgery; Modified Alderete Score; Day-care Laparoscopic Cholecystectomy; Complications; Benign Gall Bladder Disease
• ISSN: 0972-2068; 0973-9793
• DOI: 10.1007/s12262-023-03889-8

Laparoscopic cholecystectomy for benign gallbladder diseases is being practised as a day-care procedure in many centres around the world. This has been justified in view of the low rate of adverse events or complications following the surgery. There is a lack of uniform protocol for hospital admission and duration of hospital stay for elective laparoscopic cholecystectomy especially in developing countries in remote areas. The purpose of this study was to find out the possibility whether it was safe and feasible to discharge elective laparoscopic cholecystectomy patients as day-care (6 h) in a centre like ours where there is no dedicated unit for ambulatory surgery. It is a retrospective analysis of prospectively collected data. The study was conducted in the Department of general surgery in a rural healthcare setup. The suitability for discharge was assessed at 6 h after surgery. All patients were re-evaluated the following morning to rule out any negative outcomes that might have resulted from being released from the hospital at 6 h post-surgery. Total of 145 patients underwent elective laparoscopic cholecystectomy during the said period. The mean age is 39.6 years. Out of 145, 125 (86%) patients were dischargeable according to the modified Alderete score at 6 h. Duration of surgery ( p -value-0.001), occurrence of postoperative nausea and vomiting ( p -value-.002), critical view of safety visibility ( p -value-.03) and need for foley’s catheterization ( p  < 0.001) have significant associations with suitability for discharge at 6 h. Elective laparoscopic cholecystectomy surgery as a day-care procedure has its own advantages. According to the modified Alderete score, most of the patients in our study who were eligible for discharge after six hours did not experience any difficulties while they were hospitalised, making them candidates for same-day discharge. However, case selection should take care of patient and logistic factors.