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Laparoscopic Cholecystectomy is Safe and Feasible in Isolated Day-Case Units

Authors

M.J. Mullan, M.V.Seceleanu

Departments / Institutions

Department of Surgery, South West Acute Hospital, Enniskillen, UK

Publication Date

Autumn 2018

Introduction

Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. To achieve NHS target plan to perform 60% of all elective cholecystectomies as day cases, laparoscopic cholecystectomy was introduced into most day surgery units.

Aims

The aim of this study was to assess the safety and acceptability of day-case laparoscopic cholecystectomy in an isolated day-case unit.

Methods

This is a prospective study of the first twenty-one laparoscopic cholecystectomies performed in the unit between October 2017 and June 2018. Causes of failed discharges, postoperative complications and readmission rates were recorded. Patient recovery was monitored by telephone questionnaire and satisfaction was assessed at outpatient follow up.

Results

Twenty-one patients underwent laparoscopic cholecystectomy as a day case procedure. Nineteen patients were discharged on the day of surgery. Two patients were unplanned admissions and transferred to the nearby district hospital: one patient required further analgesia and one patient was transferred in view of surgery- no progression policy applied. Mean operation time was 65 min. Two patients were readmitted with wound infection and postoperative choledocholithiasis. There was no conversion to open cholecystectomy or return to theatre for emergency laparotomy. Twenty patients were satisfied with the service when reviewed in the clinic.

Conclusion

Day-case laparoscopic cholecystectomy in an isolated day surgery unit is safe and feasible with an acceptable discharge rate and level of patient satisfaction. Success depends on patient selection and education, consultant led and delivered surgery, appropriate transfer protocols in place and a policy of non-progression when encountering unexpected difficult cases.


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